Dr. Laura Witte, PhD, PA-C
Background/Purpose: Medial Branch Blocks (MBBs); and Intraarticular Injections (IIs); have shown therapeutic benefits in treating facet joint pain, but there are additional studies which investigate their diagnostic potential in determining facet joint syndrome. The use of pain relief cutoff percentage values with MBBs or II’s have also been studied to determine their predictive potential in determining patient selection of Radiofrequency Ablation (RFA) and predictive potential of post RFA positive results.
Method: A PubMed, Trip Data-base, and Google Scholar literature search was conducted with search terms “lumbar medial branch radiofrequency neurotomy”, “lumbar medial branch blocks diagnostic”, “medial branch radiofrequency”, and “facet syndrome”. Sixteen pertinent articles were retrieved, and serve as the basis for this Clinical Review.
Results: Studies identified that MBBs are the most preferred; although there is no remarkable differences between MBBs or IIs, MBBs are noted to be more preferred as they are associated with less technical errors. Studies identified which percentage cutoff values with either MBB single or dual, or IIs had greater initial pain relief, duration of pain relief, post RFA pain relief and notable mention of increased activity and reduction in pain medications. The more stringent the MBB cutoff value, the greater potential for increase MBB false negatives rates and vice versus. There is limited research within this review on pre-existing conditions, injuries or comorbidities that could impact patient selection for RFA. Additionally, this article does not review cost potential savings between procedures and injections with following RFA.
Conclusion: MBBs with pain relief cutoff values have shown to be both diagnostic and prognostic and are most preferred over II’s. Controversy remains on the best cutoff value percentage and whether to use single or dual MBBs before RFA. Stringent values may increase predictions of positive post RFA outcomes, but may also increase false negatives and restrict care from patients. The common conclusion was to not limit treatment based on more stringent patient criteria.
Gielski ML. Diagnostic Medial Branch Blocks with Pain Relief Cutoff Values Predicting Positive Radiofrequency Ablation Outcomes?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(3).
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