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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Superior long-term pain reduction and lower complication rates upon radiofrequency vs. endoscopic neurotomy for facet joint arthropathy

Vergleichende Langzeitstudie der Schmerzreduktion und Komplikationsrate zwischen Radiofrequenzdenervierung und endoskopischer Rhizotomie bei Facettengelenksarthropathie

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  • presenting/speaker Anas Afifi - Rhein Maas Klinikum, Klinik für Wirbelsäulenchirurgie, Neurochirurgie und spezielle Orthopädie, Würselen, Deutschland
  • Metin Kalkan - Rhein Maas Klinikum, Klinik für Wirbelsäulenchirurgie, Neurochirurgie und spezielle Orthopädie, Würselen, Deutschland
  • Rolf Sobottke - Rhein Maas Klinikum, Klinik für Wirbelsäulenchirurgie, Neurochirurgie und spezielle Orthopädie, Würselen, Deutschland
  • presenting/speaker Mohamad Agha Mahmoud - Rhein Maas Klinikum, Klinik für Wirbelsäulenchirurgie, Neurochirurgie und spezielle Orthopädie, Würselen, Deutschland
  • Mohammed Abujarad - Anhalt University of Applied Sciences, Hochschule Anhalt, Bernburg/Saale, Deutschland
  • Stavros Oikonomidis - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • presenting/speaker Michel Teuben - Rhein Maas Klinikum, Klinik für Wirbelsäulenchirurgie, Neurochirurgie und spezielle Orthopädie, Würselen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV285

doi: 10.3205/21dgnc270, urn:nbn:de:0183-21dgnc2706

Published: June 4, 2021

© 2021 Afifi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Radiofrequency neurotomy (RFN) of the lumbar medial branch has been considered as the standard of care for facet joint arthropathy related chronic low back pain. However, during the last decade, an upsurge of interest for endoscopic procedures was seen in spine surgery. Endoscopic neurotomy (EN) has been adopted recently as a treatment option for facet joint arthropathy. The long-term outcome of both therapies has not been compared in a standardized setting yet. We hypothesized that radiofrequency neurotomy is associated with superior long-term outcomes compared with endoscopic neurotomy.

Methods: Data from patients with facet joint arthropathy were collected prospectively between 01.01.2016 and 31.12.2019. Spinal imaging was performed in all patients to rule out other pathologies. Patients were grouped based on treatment modality into radiofrequency neurotomy group (Gr.RFN (n=36)) and endoscopic neurotomy group (GR. EN (n=29)). We compared the following parameters over time (1 year) and between groups: Core Outcome Measures Index for the back (COMI), VAS (Visual Analog Scale)-scores, complications and financial costs.

Results: 65 patients (35 female) with a median (IQR) age of 62 (54-72) years were included. Pre-interventionally, patients had a median (IQR) COMI-Score of 8.6 (7.7-9.0) and a median (IQR) VAS of 8.0 (7.0-9.0). No statistically significant differences in baseline parameters were encountered. After intervention, a significant drop in VAS occured in both conditions. Thereafter, pain-scores rose gradually within the first 12 months in the EN group, whereas VAS-levels in the RFN group remained unaltered. Complication rates were significantly lower in the RFN group, compared with EN-patients (p<0.007). Total costs were significantly lower in RFN-procedures (p<0.05), and earlier return to work was documented in patients treated by RFN than those individuals treated by EN (p<0.05).

Conclusion: The current comparative study reveals that radiofrequency neurotomy of the lumbar medial branch is associated with enhanced long-term pain relief, lower complication rates and lower costs than endoscopic neurotomy for facet joint arthropathy related chronic low back pain.