Korean J Pain.  2017 Oct;30(4):296-303. 10.3344/kjp.2017.30.4.296.

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

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. anzi1md@naver.com
  • 2Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.

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.

Keyword

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

MeSH Terms

Ablation Techniques
Catheter Ablation
Fasciculation
Humans
Low Back Pain
Needles
Prognosis
Zygapophyseal Joint

Figure

  • Fig. 1 Flow diagram of patient allocation.

  • 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 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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