Artikel
Zygapophysial joint pain in post lumbar surgery syndrome. The efficacy of medial branch blocks and radiofrequency neurotomy
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Autoren
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S. Klessinger
- Nova Clinic, Biberach, Germany
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To investigate the relevance of the zygapophysial joints as a pain source in patients after disc surgery and to determine the efficacy of therapeutic medial branch blocks and radiofrequency neurotomy.
Methods: Review of charts of all patients who underwent lumbar disc surgery during a time period of two years. Patients with persistent postsurgical axial pain were first treated with a therapeutic medial branch block. Patients with recurrent pain were considered for radiofrequency neurotomy after being tested with a second medial branch block. 80% pain relief was required. Positive treatment response after radiofrequency neurotomy was defined for at least 50% pain reduction.
Results: 479 patients after microsurgical lumbar disc operations were examined. Persistent axial back pain (non-radicular pain) occurred in 110 patients. 57 of these patients were successfully treated with a single therapeutic medial branch block, 19 patients did not respond. The remaining 34 patients were treated with radiofrequency neurotomy. In 20 patients, a pain reduction of at least 50% for a minimum of 6 month was achieved. Together 70% of the patients with non-radicular back pain after disc surgery were treated successfully with medial branch blocks and radiofrequency neurotomy. Significantly more recurrent disc herniations are found in the non-responder groups compared to the successfully treated patients (33.3% versus 3.9%).
Conclusions: Only limited information exists about the efficacy of interventional procedures in the management of pain after disc surgery. This is the first study that suggests that therapeutic interventions, in particular medial branch blocks and radiofrequency neurotomy, are an effective and rational therapy for these patients.
