Percutaneous radiofrequency facet joint denervation with monitoring of compound muscle action potential of the multifidus muscle group for treating chronic low back pain: a preliminary report

J Spinal Disord Tech. 2014 Oct;27(7):E262-7. doi: 10.1097/BSD.0000000000000107.


Study design: A retrospective review.

Objective: The aim of this study was to study the effectiveness of percutaneous radiofrequency neurotomy of facet joints by monitoring compound muscle action potentials (CMAPs) of the multifidus muscle group as an objective index of treatment efficacy.

Summary of background: Percutaneous radiofrequency neurotomy of the medial branches of the dorsal rami of the lumbar nerves is a widely accepted treatment for chronic lumbar intervertebral joint pain. However, its success rate has varied in different studies because an objective method for evaluating the facet joint denervation is lacking.

Methods: Fifty-five patients (age range, 19-76 y; mean age, 55 y) with low back pain persisting for ≥3 months, in whom facet block and/or block of the medial branch of the dorsal ramus were only temporarily effective, were included. The Japanese Orthopaedic Association (JOA) scoring system for back pain was used for clinical assessment. JOA scores were measured before treatment and 1 week, 3 months, 6 months, and 12 months afterward. The improvement rate was calculated with ≥40% improvement rate defined as successful, and the success rate was subsequently evaluated.

Results: The patient success rate was 75% (41/55) at 1 week, 71% (39/55) at 3 months, 60% (33/55) at 6 months, and 51% (28/55) at 12 months after treatment. Two cases had minor postoperative complications, which were localized burning pain lasting <1 week at the site of electrode insertion.

Conclusions: Our results suggest that percutaneous radiofrequency facet joint denervation with CMAPs monitoring is a safe, long-lasting, and effective treatment for chronic facet joint pain. CMAP monitoring may be useful as an objective index for facet denervation.

MeSH terms

  • Action Potentials / physiology*
  • Adult
  • Aged
  • Catheter Ablation / methods*
  • Chronic Pain / physiopathology
  • Chronic Pain / surgery
  • Denervation / methods*
  • Female
  • Humans
  • Low Back Pain / physiopathology
  • Low Back Pain / surgery*
  • Lumbar Vertebrae / innervation
  • Lumbar Vertebrae / physiology
  • Lumbar Vertebrae / surgery
  • Lumbosacral Region / innervation
  • Lumbosacral Region / physiology
  • Lumbosacral Region / surgery
  • Male
  • Middle Aged
  • Paraspinal Muscles / innervation
  • Paraspinal Muscles / physiology*
  • Pilot Projects
  • Retrospective Studies
  • Spinal Nerves / physiology
  • Spinal Nerves / surgery
  • Treatment Outcome
  • Young Adult
  • Zygapophyseal Joint / innervation
  • Zygapophyseal Joint / physiology
  • Zygapophyseal Joint / surgery*