The Effectiveness of Cervical Medial Branch Radiofrequency Ablation for Chronic Facet Joint Syndrome in Patients Selected by a Practical Medial Branch Block Paradigm Taylor Burnham, DO, Aaron Conger, DO, Fabio Salazar, Russell Petersen, Richard Kendall, DO, Shellie Cunningham, Masaru Teramoto, PhD, MPH, and Zachary L. McCormick, MD Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA Correspondence to: Taylor Burnham, DO, Division of Physical Medicine and Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84103, USA. Tel: 801-587-5458; Fax: 801-587-7111; E-mail: taylor.burnham@hsc.utah.edu. Funding sources: There were no sources of funding for this study. Conflicts of interest: Zachary L. McCormick, MD, serves on the Board of Directors of the Spine Intervention Society. There are no other potential con- flicts of interest to disclose on the part of any of the other authors. Abstract Background. Cervical medial branch radiofrequency ablation (CMBRFA) is an effective treatment for facetogenic pain in patients selected by Spine Intervention Society (SIS) guidelines of 100% symptom improvement with dual medial branch blocks (MBBs) 6 placebo block. Patient selection for CMBRFA using 80% symptom improvement after dual concordant MBBs is common; however, this has not been studied. Objective. To evaluate the effectiveness of CMBRFA and compare outcomes in individuals selected by 80–99% vs 100% symptom improvement with dual con- cordant MBBs. Design. Cross-sectional cohort study. Methods. Medical records of 87 consecutive patients were reviewed; 50 met inclusion criteria. A standardized telephone survey was performed at six or more months post-CMBRFA to query numerical rating scale (NRS) pain and patient global impression of change (PGIC) scores. The primary outcomes were the proportion of patients reporting 50% reduction of index pain. Results. At a mean follow-up time of 16.9 6 12.7 months, 54% (95% confidence interval [CI] ¼ 35–73%) and 54% (95% CI ¼ 32–74%) of the 80–99% and 100% MBBs groups, respectively, reported 50% pain reduction. Between-group comparison showed a relative risk of 0.99 (95% CI ¼ 0.59–1.66) for meeting the primary outcome. Seventy percent (95% CI ¼ 56– 81%) of patients reported a PGIC score consistent with “improved or very much improved” at follow-up. Conclusions. CMBRFA is an effective treatment in patients who report 80% symptom relief with dual concordant MBBs. The present study demonstrated an overall 50% pain reduction rate of 54% and no significant difference between those selected by 80–99% vs 100% symptom relief with dual concordant MBBs. Key Words: neck; pain; medial branch; ablation Introduction The National Center for Health Statistics reported neck pain as the third most commonly reported musculoskele- tal complaint in the United States [1]. Cervical zygapo- physial or “facet” joint pain has a prevalence of 25– 45% of patients with chronic neck pain [2–5]. Verified cervical facetogenic pain can be effectively treated with cervical medial branch radiofrequency ablation (CMBRFA). CMBRFA utilizes thermal energy to coagulate the sensory nerves, thus interrupting the noci- ceptive input from the painful facet joint(s). The Spine Interventional Society (SIS) recommends that patient selection for CMBRFA be based on 100% symptom resolution after diagnostic dual medial branch blocks (MBBs) 6 a placebo control block [6–9]. These se- lection criteria have been validated and reduce the false- positive rate of the MBB paradigm. A single MBB has a false-positive rate of 27% (95% confidence interval [CI] V C The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2071 Pain Medicine, 21(10), 2020, 2071–2076 doi: 10.1093/pm/pnz358 Advance Access Publication Date: 5 February 2020 Original Research Article Downloaded from https://academic.oup.com/painmedicine/article/21/10/2071/5727720 by guest on 28 February 2023