TY - JOUR
T1 - Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool before Lumbar Facet Radiofrequency Denervation
T2 - A Multicenter, Case-Control Study
AU - Cohen, Steven P.
AU - Moon, Jee Youn
AU - Brummett, Chad M.
AU - White, Ronald L.
AU - Larkin, Thomas M.
N1 - Publisher Copyright:
Copyright © 2015 by American Society of Regional Anesthesia and Pain Medicine.
PY - 2015/7/11
Y1 - 2015/7/11
N2 - Background Medial branch blocks (MBBs) and intra-articular (IA) facet joint injections are both used to diagnose facet joint pain and are presumed to be equivalent. No study has sought to determine which has a better prognostic value before radiofrequency (RF) denervation. Methods A case-control study was performed at 4 institutions in which RF denervation outcomes in patients who obtained 50% or more pain relief from either MBB (n = 212) or IA injections (n = 212) were compared. "Control" patients (MBB) were matched to "cases" by treating physician, last name, and date of treatments. During data mining, 87 patients were identified who underwent RF ablation after receiving both IA injections and MBB and were used for secondary analyses. Results A total of 70.3% of MBB patients experienced 50% or more pain relief at the 3-month follow-up versus 60.8% in those who underwent IA injections (P = 0.041). In multivariable analysis, undergoing MBB was associated with RF treatment success (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.0-2.39; P = 0.036), whereas opioid use (OR, 0.52; 95% CI, 0.34-0.79; P = 0.002) and previous back surgery (OR, 0.60; 95% CI, 0.38-0.95; P = 0.028) were associated with treatment failure. No significant differences were noted between MBB alone and combination treatment or single versus multiple blocks. In the secondary multivariable analysis including the combination IA + MBB group, MBB alone was again independently associated with an RF ablation treatment success (OR, 1.73; 95% CI, 1.12-2.67; P = 0.014). Conclusions When used as a prognostic tool before lumbar facet radiofrequency, MBB may be associated with a higher success rate than IA injections. Our results should be confirmed by large, prospective, randomized studies.
AB - Background Medial branch blocks (MBBs) and intra-articular (IA) facet joint injections are both used to diagnose facet joint pain and are presumed to be equivalent. No study has sought to determine which has a better prognostic value before radiofrequency (RF) denervation. Methods A case-control study was performed at 4 institutions in which RF denervation outcomes in patients who obtained 50% or more pain relief from either MBB (n = 212) or IA injections (n = 212) were compared. "Control" patients (MBB) were matched to "cases" by treating physician, last name, and date of treatments. During data mining, 87 patients were identified who underwent RF ablation after receiving both IA injections and MBB and were used for secondary analyses. Results A total of 70.3% of MBB patients experienced 50% or more pain relief at the 3-month follow-up versus 60.8% in those who underwent IA injections (P = 0.041). In multivariable analysis, undergoing MBB was associated with RF treatment success (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.0-2.39; P = 0.036), whereas opioid use (OR, 0.52; 95% CI, 0.34-0.79; P = 0.002) and previous back surgery (OR, 0.60; 95% CI, 0.38-0.95; P = 0.028) were associated with treatment failure. No significant differences were noted between MBB alone and combination treatment or single versus multiple blocks. In the secondary multivariable analysis including the combination IA + MBB group, MBB alone was again independently associated with an RF ablation treatment success (OR, 1.73; 95% CI, 1.12-2.67; P = 0.014). Conclusions When used as a prognostic tool before lumbar facet radiofrequency, MBB may be associated with a higher success rate than IA injections. Our results should be confirmed by large, prospective, randomized studies.
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U2 - 10.1097/AAP.0000000000000229
DO - 10.1097/AAP.0000000000000229
M3 - Article
C2 - 26066382
AN - SCOPUS:84953850975
SN - 1098-7339
VL - 40
SP - 376
EP - 383
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
IS - 4
ER -