A Novel Modality for Facet Joint Denervation: Cooled Radiofrequency Ablation for Lumbar Facet Syndrome. A Case Series

Background: While cooled radiofrequency ablation (C-RFA) appears to be a promising technology for joint denervation, outcomes of this technique for the treatment of lumbar facet syndrome have not been described. We report clinical outcomes in a case series of patients treated with C-RFA for lumbar facet syndrome. Methods: Consecutive patients aged 18-60 years diagnosed with lumbar facet syndrome, confirmed by =75% symptom relief with at least one set of diagnostic medial branch nerve blocks, who underwent C-RFA between January 2007 and December 2013 in an urban academic pain center were included. The respective proportions of participants who reported =50% improvement in pain in function were calculated. Change in median NRS score, daily morphine equivalent consumption (DME), and medication quantification scale III (MQS III) score were measured. Results: Twelve patients underwent C-RFA; three were lost to follow-up. The median and 25%-75% inter quartile range (IQR) for age was 44 years (35, 54). The median duration of follow-up was 34 months, IQR (21, 55). The percentage and 95% confidence interval (CI) of patients who reported =50% improvement in pain was 33% CI (12%, 64%) and in function was 78%, CI (41%, 96%). There was no change in DME or MSQ III score. Approximately 50% of patients sought additional healthcare by long-term follow-up. No complications were reported. Conclusions: This case series suggest that C-RFA may improve function and to a lesser degree pain at long-term follow-up. A randomized, controlled trial is warranted.