Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy

Jae Chul Koh, Do Hyeong Kim, Youn Woo Lee, Jong Bum Choi, Dong Hun Ha, Ji Won An, Jae Chul Koh, Do Hyeong Kim, Youn Woo Lee, Jong Bum Choi, Dong Hun Ha, Ji Won An

Abstract

Background: To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome.

Methods: We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: 'Complete', when twitching was observed at all needles; 'Partial', when twitching was present at 1 or 2 needles; and 'None', when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed.

Results: The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively (P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. (P = 0.03).

Conclusions: Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.

Keywords: Ablation technique; Facet joint; Fasciculation; Innervation; Lower back pain; Prognosis; Radiofrequency catheter ablation.

Figures

Fig. 1. Flow diagram of patient allocation.
Fig. 1. Flow diagram of patient allocation.
Fig. 2. Fluoroscopic images of the radio-frequency…
Fig. 2. Fluoroscopic images of the radio-frequency (RF) needle position. A 20-gauge radiofrequency needle (R) was placed following the insertion of a guide needle (G) so that itis passed the point of guide needle and lies parallel/close to the target medial branch. (A, B) The anteroposterior/lateral view of the L4/5 level facet joint neurotomy. (C, D) The anteroposterior/lateral view of the L5/S1 level facet joint neurotomy. AP: anteroposterior, OBL: oblique, LAT: lateral.
Fig. 3. Duration of RF-MB according to…
Fig. 3. Duration of RF-MB according to the group by paravertebral muscle twitching. The duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively.

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