The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지

Raiofrequency Neurotomy for Lumbar Facet Joint Pain in the Patients with Failed Back Surgery Syndrome

척추수술 후 증후군 환자에서 관찰된 추간관절통에 대한 고주파신경절리술

  • Lee, Jeong Hoon (Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University) ;
  • Shim, Jae Chol (Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University)
  • 이정훈 (한양대학교 의과대학 마취통증의학교실) ;
  • 심재철 (한양대학교 의과대학 마취통증의학교실)
  • Received : 2005.09.27
  • Accepted : 2005.11.24
  • Published : 2005.12.10
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A significant number of patients complain of persistent pain or neurologic symptoms after lower back surgery. It is reported that facet joint pain plays a role in failed back surgery syndrome. To the best of our knowledge, there are few studies that have investigated the outcome of radiofrequency neurotomy in the patients with failed back surgery syndrome. Methods: The study group was composed of thirteen patients who were operated on due to their low back pain, and they displayed no postoperative improvement. All the patients underwent double diagnostic block of the lumbar medial branch of the dorsal rami with using 0.5% bupivacaine. The patients who revealed a positive response to the double diagnostic block were then treated with percutaneous radiofrequency neurotomy. The effect on their pain was evaluated with using a 4 point Likert scale. Results: Eleven patients revealed a positive response to the double diagnostic block. Ten patients were given percutaneous radiofrequency neurotomy. Nine patients showed sustained pain relief for 3 months after the percutaneous radiofrequency neurotomy. Conclusions: We found lumbar facet joint syndrome in the patients with failed back surgery syndrome by performing double diagnostic block and achieving pain relief during the short term follow-up after percutaneous radiofrequency neurotomy of the lumbar zygapophysial joints. This suggested that facet joint pain should be included in failed back surgery syndrome.

Keywords

References

  1. Schofferman J, Reynolds J, Herzog R, Covington E, Dreyfuss P, O'Neill C: Failed back surgery: eriology and diagnostic evaluation. Spine J 2003; 3: 400-3.
  2. Finneson BE: A lumbar disc surgery predictive score card. Spine 1978; 3: 186-8.
  3. Robertson JT: Role of peridural fibrosis in the failed back: a review. Eur Spine J 1996; 5(Suppl 1): S2-6.
  4. Wilkinson HA: Failed-back syndrome. J Neurosurg 1989; 70: 65960.
  5. Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, Mcculloch j A: Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg Am 1979; 61: 201-7.
  6. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N: Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity) Spine 1994; 19: 1132-7.
  7. Schwarzer AC, Wang SC, Bogduk N, Mcnaught PJ, Laurent R: Ptevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 1995; 54: 100-6.
  8. Sluijrer ME: The use of radiofrequency lesions for pain relief in failed back patients. Int Disabil Stud 1988; 10: 37-43.
  9. Gocer AI, Cetinalp E, Tuna M, Ildan F, Bagdatoglu H, Haciyakupoglu S: Percutaneous radiofrequency rhizotomy of lumbar spinal facets: the results of 46 cases. Neurosurg Rev 1997; 20: 114-6.
  10. Zanoli G: Outcome assessment in lumbar spine surgery. Acta Orthop 2005; 76(Suppl): 5-47.
  11. Anderson VC, Israel Z: Failed back surgery syndrome. Curr Rev Pain 2000; 4: 105-11.
  12. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB: Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 1981; 191-9.
  13. Finnegan WJ, Fenlin JM, Marvel JP, Nardini RJ, Rothman RH: Results of surgical intervention in the symptomatic multiply-operated back patient. Analysis of sixty-seven cases followed for three to seven years. J Bone Joint Surg Am 1979; 61: 1077-82.
  14. Murphy WA: The facet syndrome. Radiology 1984; 151: 533.
  15. Mooney V, Robertson J: The facet syndrome. Clin Orthop Relat Res 1976; 149-56.
  16. Sluijter ME: The role of radiofrequency in failed back surgery patients. Curr Rev Pain 2000; 4: 49-53.
  17. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Tchang S, De Korompay V, Shannon R: Lumbar spinal nerve lateral entrapment. Clin Orthop Relat Res 1982; 171-8.
  18. Bogduk N: International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part I: Zygapophysial joint blocks. Clin J Pain 1997; 13: 285-302.
  19. Lord SM, Barnsley L, Bogduk N: The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain 1995; II: 208-13.
  20. Dreyfuss P, Halbrook B, Pauza K, Joshi A, Mclarty J, Bogduk N: Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000; 25: 1270-7.
  21. Kaplan M, Dreyfuss P, Halbrook B, Bogduk N: The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint. A physiologic challenge. Spine 1998; 23: 1847-52.
  22. Stolker RJ, Vervest AC, Groen GJ: The management of chronic spinal pain by blockades: a review. Pain 1994; 58: 1-20.