Percutaneous Radio-Frequency Neurotomy for Chronic Cervical Zygapophyseal-Joint Pain
Susan M. Lord, B.Med., Ph.D., Leslie Barnsley, B.Med., Ph.D., Barbara J. Wallis, B.Sc., Gregory J. McDonald, M.B., B.S., and Nikolai Bogduk, M.D., Ph.D.
Background Chronic pain in the cervical zygapophyseal jointsis a common problem after whiplash injury, but treatment isdifficult. Percutaneous radiofrequency neurotomy can relievethe pain by denaturing the nerves innervating the painful joint,but the efficacy of this treatment has not been established.
Methods In a randomized, double-blind trial, we compared percutaneousradio-frequency neurotomy in which multiple lesions were madeand the temperature of the electrode making the lesions wasraised to 80°C with a control treatment using an identicalprocedure except that the radio-frequency current was not turnedon. We studied 24 patients (9 men and 15 women; mean age, 43years) who had pain in one or more cervical zygapophyseal jointsafter an automobile accident (median duration of pain, 34 months).The source of their pain had been identified with the use ofdouble-blind, placebo-controlled local anesthesia. Twelve patientsreceived each treatment. The patients were followed by telephoneinterviews and clinic visits until they reported that theirpain had returned to 50 percent of the preoperative level.
Results The median time that elapsed before the pain returnedto at least 50 percent of the preoperative level was 263 daysin the active-treatment group and 8 days in the control group(P = 0.04). At 27 weeks, seven patients in the active-treatmentgroup and one patient in the control group were free of pain.Five patients in the active-treatment group had numbness inthe territory of the treated nerves, but none considered ittroubling.
Conclusions In patients with chronic cervical zygapophyseal-jointpain confirmed with double-blind, placebo-controlled local anesthesia,percutaneous radio-frequency neurotomy with multiple lesionsof target nerves can provide lasting relief.
Source Information
From the Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan (S.M.L., L.B., B.J.W., G.J.M., N.B.), and the Mater Misericordiae Hospital, Waratah (S.M.L., L.B., G.J.M., N.B.) — both in New South Wales, Australia.
Address reprint requests to Dr. Lord at the Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
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