Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial

Abstract

Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months (P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain.

Figures

Fig. 1

Mean low back pain before and after cryodenervation as measured on visual analogue scale: data of all patients, including failures (0= before therapy; 6 W =6 weeks after therapy; 3 M =3 months after therapy; 6 M =6 months after therapy; 12 M =12 months after therapy; error bars reflect standard deviation; *P<0.0001)

Fig. 2

Mean low back pain before and after cryodenervation as measured on visual analogue scale, excluding "failures" at 6 weeks (0= before therapy; 6 W =6 weeks after therapy; 3 M =3 months after therapy; 6 M =6 months after therapy; 12 M =12 months after therapy; error bars reflect standard deviation; *P<0.0001)

Fig. 3

Mean limitation of activities of daily living before and after cryodenervation: data of all patients, including failures at 6 weeks (simplified McNab score; y-axis: 3= severe, 2= moderate, 1= light, and 0= none; x-axis: 0= before therapy, 6 W=6 weeks after therapy, 3 M=3 months after therapy, 6 M=6 months after therapy, and 12 M=12 months after therapy; *P<0.0001)

Fig. 4

Patient distribution in success, partial success and failure categories (6 W =6 weeks after therapy; 3 M =3 months after therapy; 6 M =6 months after therapy; 12 M =12 months after therapy)