Facet Joint Injection versus Radiofrequency Facet Neurotomy for Treatment of Lumbar Facet Joint Arthropathy

Background Data: The facet arthropathy is the source of persistent low back pain that could refer to both lower limbs. The referred lower limb pain of facet origin may refer to the proximal lower extremities, buttocks, and/or back. The medial branches of the dorsal rami are the main innervations of the facet joints. Blocking pain transmission through these medial branches can be performed by conventional nerve block, intra-articular injection, and radiofrequency ablation.Purpose: The aim of this study was to compare the therapeutic benefits of the conventional facet joint block and the non pulsed radiofrequency denervation to the medial branches of dorsal rami in the treatment of facet arthropathy in non-surgical patients.Study Design: This study was a randomized clinical study included 58 patients suffering from chronic back pain due to facet joint arthropathy.Patients and Methods: Fifty-eight patients were included in this study. The outcome measure was: the visual analogue score (VAS) for low back pain. Patients were randomized into two groups: Group A: included 29 patients who were subjected to conventional facet join injection with steroids. Group B: included 29 patients who were subjected to radiofrequency denervation of the facet joints. All patients were regularly assessed through the follow up period of six months post intervention.Results: The study included 58 patients, 26 males; the mean age was 42.2±9.57 years. In group A, who had facet steroids injection, the mean preoperative VAS was 4.86±0.97, the mean post injection at one-week VAS was reduced to 4.29±0.94, at three months the mean VAS was 4.11±0.84, and at the sixth months; it dropped to 2.64±0.91. Preoperative and after six months VAS changes were not significant (P=0.1654). In group B, who had facet radiofrequency ablation, the mean preoperative VAS was 4.73±0.2, the mean post injection at one-week VAS was reduced to 3.40±0.12, at three months the mean VAS was 2.63±0.18, and at the sixth months it dropped to 1.8±0.14. Preoperative and after six months VAS changes were significant (P=0.0012).Conclusion: Both facet joint steroids injection and radiofrequency ablation have a significant result in non-surgical management of low back pain due to facet arthropathies. None-pulsed radiofrequency ablation has better results in pain relief at the third and sixth month post intervention when compared to facet steroids injection. (2018ESJ164)