Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Evan M. Berlin, MD: No financial relationships or conflicts of interest
Objective: The zygapophysial (facet) joint has been indicated as the source of pain in 36-60% of patients with chronic neck pain. Medial branch radiofrequency neurotomy (RFN) is a safe and effective intervention to treat cervical facet-mediated pain. Medial branch block (MBB) is currently the standard for diagnosis of facet joint pain and can be used to select patients for RFN, though the ideal MBB diagnostic paradigm is unclear. Some practitioners argue for a single MBB, others argue for dual MBB, and others support a no-block protocol. The objective is to determine the extent to which clinical practice using dual Cervical MBBs and a ≥80% pain relief cut off approximates the statistical foundational studies upon which guidelines from SIS and Medicare LCD were based.
Design: Retrospectively identified and reviewed a cohort of all patients undergoing a first cervical MBB between Jan 1 and Dec 31, 2019 to determine frequency and characteristics of subsequent MBBs and RFNs.Setting : Single academic institutionParticipants : 61 patients
Interventions: Cervical MBB and RFN
Main Outcome Measures: Matriculation from dual MBBs to RFN
Results: 61 patients underwent initial cervical MBB. 38 (62%) had a positive first block and progressed to a second MBB. Of these, 27 (71%) progressed to RFN.Conclusions: Using a dual-MBB paradigm with ≥80% pain relief cutoff, 44% (27/61) of patients undergoing initial cervical MBB proceeded to RFN, suggesting that 56% may have had non-facet etiologies for cervical pain. Increasing the specificity of patient selection for RFN increases likelihood of successful outcome, though this must be balanced against the risk of withholding potentially therapeutic treatment to patients who may benefit from the intervention. Debate surrounding appropriateness of such protocols continues and underscores the importance of assessing the effect of such protocols. This cohort shows that a dual block paradigm in clinical practice is feasible and confers clinical utility in selecting patients for RFN.
Level of Evidence: Level III
To cite this abstract in AMA style:
Berlin EM, Sherwood DH, Schneider B, Gardner J, Epps A, Haring RS. Dual Medial Branch Blocks and Progression to Radiofrequency Neurotomy for Cervical Zygapophysial Arthropathy [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/dual-medial-branch-blocks-and-progression-to-radiofrequency-neurotomy-for-cervical-zygapophysial-arthropathy/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dual-medial-branch-blocks-and-progression-to-radiofrequency-neurotomy-for-cervical-zygapophysial-arthropathy/