Pain-Free Survival After Endoscopic Rhizotomy Versus Radiofrequency for Lumbar Facet Joint Pain: A Real-World Comparison Study

Abstract

Background: Endoscopic rhizotomy (ER) of the medial branch has been recently developed for the treatment of lumbar facet joint pain (LFJP). However, there are no studies comparing the pain-free duration after ER and radiofrequency (RF).

Objectives: To evaluate the long-term outcomes for pain and physical function in patients who underwent ER versus RF for LFJP and compare their pain-free survival.

Study design: Open label, prospective, real-world study that includes patients treated with ER or RF at a single center between November 2017 and February 2020.

Setting: The research took place within a single university-based neuro-spine center.

Methods: Patients with a positive diagnostic medial branch block (>= 80% pain relief) were treated with ER or RF. Numeric rating scale (NRS), Oswestry Disability Index (ODI), and Global Impression of Change (GIoC) were obtained at the baseline, and at 6 months and 12 months postoperatively. The duration of pain-free time was recorded at every follow-up. The final follow-up was conducted in March 2021.

Results: Of 55 patients with LFJP, 19 underwent ER, and 36 underwent RF. Both ER and RF groups showed significant decreases in NRS and ODI scores at 6 months and 12 months compared with baseline (P < 0.001). ER had significantly better efficacy than RF in NRS, ODI, and GIoC scores at 6 and 12 months (P < 0.05). The pain-free survival curves showed that the median pain-free duration was 20 months and 10 months in ER and RF, respectively.

Limitation: Patients were not randomized to different groups, which may have led to bias.

Conclusions: Both ER and RF can improve the pain and physical function in patients with LFJP. ER is associated with a longer operative duration and medical expenses; however, it provides more sustained efficacy than RF. The surgical choice should depend on the patients' specific conditions.

Keywords: endoscopic; facet joint; medial branch; pain-free survival; radiofrequency; real-world study; rhizotomy; Low back pain.