Randomized pragmatic pilot trial comparing perpendicular thin electrodes versus parallel thick electrodes approaches for lumbar medial branch neurotomy in facetogenic low back pain

Javier De Andrés Ares, Fernando Gilsanz
Pain Practice: the Official Journal of World Institute of Pain 2020 June 22

OBJECTIVES: Although there are different ways of performing medial branch neurotomy on facetogenic low back pain, few studies have compared clinical outcomes of a parallel technique over the medial branch versus a perpendicular technique. We investigated differences in pain outcome with both techniques.

DESIGN: This was a prospective, pilot, randomized, pragmatic trial (double-blinded in diagnostic phase).

SETTING: A comparative pilot trial was conducted at an academic pain centre.

METHODS: Patients who did not respond to conservative medications and had severe lumbar pain for more than 3 months (VAS≥65) were included. A double diagnostic block with local anaesthetic and placebo was performed, double blinded. Patients who had an 80% relief from the local anaesthetic and no substantial relief from placebo were randomized to receive a medial branch neurotomy placing an electrode parallel or perpendicular to the medial branch, under fluoroscopy.

PRIMARY OUTCOME: differences in Visual Analogue Scale at 1, 3 and 6 months.

SECONDARY OUTCOMES: Oswestry Disability Index, Roland Morris Questionnaire and other functional Likert scales.

RESULTS: Forty-three consecutive patients were randomized to parallel (n=20) or perpendicular (n=23) neurotomy. There were no significant differences in Visual Analogue Scale, Oswestry or Roland Morris at 1, 3 or 6 months between groups. Statistically significant differences were found in the categorical analysis at six months, in the evolution of pain, Oswestry, Roland Morris and some Likert scales in favour of the parallel group.

CONCLUSIONS: There are differences at 6 months in the categorical analysis of the evolution of pain, Oswestry, Roland Morris and in some functional Likert scales, all in favour of the parallel group.

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