Universität zu Köln

Afifi, Anas (2024). Lumbar facet joint radiofrequency denervation therapy for recurrent chronic low back pain: enhanced outcome compared with chemical neurolysis (ethyl alcohol 95% or glycerol 20%). PhD thesis, Universität zu Köln.

PDF Endversion _ Disseration_ Afifi _ August 2024 _mit Unterschrift.pdf - Published Version Download (4MB)

Abstract

Abstract INTRODUCTION: Chronic low back pain is a major source of disability and work productivity loss worldwide. Treatment modalities for back pain due to facet joint arthropathy include chemical neurolysis (Ethyl Alcohol or Glycerol) and radiofrequency denervation of lumbar facet joints. Long-term outcome of these semi-invasive techniques, however, are currently unclear. We hypothesize that radiofrequency denervation is associated with superior pain abolishment and less complications than chemical neurolysis. METHODS: For this prospective follow-up study, we enrolled patients between 01.12.2017 and 01.12.2019. Adult patients with recurrent chronic low back pain, resistant to non-invasive therapy and steroids injections were included. Spinal imaging was performed to exclude alternative diagnoses. Patients were grouped based on treatment modality. The following groups were compared: radiofrequency denervation (Gr. RFD), chemical neurolysis with Ethyl-Alcohol 95% (Gr. EA-95), or Glycerol 20% (Gr. Gly-20). The Core Outcome Measures Index for the back (COMI), World Health Organization (WHO) pain ladder level and VAS (Visual Analog Scale) scores were determined. Furthermore, complications were documented and compared between groups. The outcome was determined pre-interventional, after 6 weeks, 6 and 12 months. RESULTS: A total of 95 patients (60 females and 35 males) with a mean age of 63.7 years were included. Prior to intervention, a mean COMI score of 8.31 and a VAS score of 8.01 were encountered. A total of 30 patients underwent RFD; 35 patients were treated with EA-95; and 35 patients were exposed to Glycerol 20% neurolysis. Subjects had an average WHO pain ladder level of 1.39. No statistically significant differences were found between the three groups. However, upon intervention, patients treated with RFD had significantly lower VAS levels compared to those treated with Ethyl Alcohol after 6 weeks (VAS: 4.33 vs. 6.12, (P<0.05)). Furthermore, after 6 months, both VAS and COMI scores were significantly decreased in RFD patients compared to those treated with Gly-20 (respectively, VAS: 4.42 vs. 6.64, P<0.01 and COMI: 5.08 vs. 7.43, P<0.01). After 12 months, VAS scores were significantly lower in Gr. RFD vs Gr. Gly-20 (4.72 vs. 7.44, P<0.05), whereas complications rates were higher in patients treated with EA-95 than with RFD and Gly-20 (30% vs. 6.7% and 2.9%, P<0.05). CONCLUSION: This prospective follow-up study is the first to show that in patients with recurrent chronic lower back pain, radiofrequency denervation therapy is associated with improved pain relief and quality of life compared to alternative modalities of chemical neurolysis. Furthermore, more complications are seen in patients treated with chemical neurolysis using Ethyl Alcohol 95% than other treatment options. In our view, in the absence of contraindications (such as a pacemaker/cochlear implants), radiofrequency denervation should be considered the treatment of choice in patients with symptomatic facet arthropathy.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Afifi, Anas anas-af@hotmail.com UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-735568
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Chirurgie > Abteilung Unfallchirurgie (Klinik und Poliklinik für Orthopädie und Unfallchirurgie)
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language recurrent chronic low back pain English Lumbar facet joint English radiofrequency denervation therapy English chemical neurolysis English
Date of oral exam:	16 August 0224
Referee:	Name Academic Title Sobottke, Rolf Professor Dr.med. Kammerer, Tobias Universitätsprofessor Dr. med.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/73556