Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Low back pain caused by degenerative spondylolisthesis can be successfully treated by minimally-invasive radiofrequency therapy, researchers reported here. In 67 cases of degenerative spondylolisthesis, greater than a 50% reduction in pain was achieved in 64.2% of the patients, said Stephan Klessinger, MD, a neurosurgeon at Nova Clinic, Biberach in Baden-Wurttemburg, Germany, at the annual meeting of the American Academy of Pain Medicine. In a retrospective chart review of 1,470 patients who underwent radiofrequency therapy for low back pain over a three-year period, 83 of whom had spondylolisthesis -- abnormalities of the zygapophysial joints. "Degenerative spondylolisthesis is one of the major causes for low back pain," he told MedPage Today at his poster presentation. "Radiofrequency neurotomy seems a rational therapy. Our objective was to determine if radiofrequency neurotomy is effective for patients with low back pain and degenerative spondylolisthesis." The treatment involves inserting needles through the skin under imaging guidance to locations near the lower back vertebrae. Radiofrequency waves are then used to destroy impinged nerves in the lumbar region believed to be causing the patients' pain. Klessinger said that, to his knowledge, the study was the first attempt "to determine the effect of radiofrequency neurotomy in patients with degenerative spondylolisthesis." Because the treatment does not require surgery, "it is worth trying radiofrequency neurotomy because if it doesn't work, you can still do surgery if there are no other options," he said. However, his study showed that, for the majority of patients, radiofrequency nerve ablation was effective in markedly reducing pain. All of the patients included in his analyses had undergone magnetic resonance imaging of the spine. Patients with previous spinal surgeries and those with neurological deficits were excluded. For the purposes of the study, patients were considered successfully treated with radiofrequency neurotomy if the treatment produced at least a 50% reduction in self-reported pain and patients also said they were satisfied with the outcome of the procedure. "This procedure is greatly underutilized for treating low back pain," Craig Cartia, MD, an anesthesiologist with the Sacred Heart Medical Group in Pensacola, Fla., told MedPage Today. "This is a fairly common procedure that can be performed pretty accurately with success. We can see these patients get better and achieve long-term pain relief with this procedure," he remarked. Cartia said he believes that with careful patient selection, the percentage of patients with spondylolisthesis might also be higher. In his report, Klessinger noted that patients who appeared to have abnormalities within the zygapophysial joint did better than patients with osteoarthritis and stenosis in the same area. Most of the patients -- 52 of in the study group -- were between ages 60-79. Using the 5-Grade Meyerding Grading System, Klessinger found that 42 of the patients had Meyerding Grade 1 abnormality -- up to a 24% "slip" of the disc; and 25 patients were classified as Meyerding Grade 2 -- a 25% to 49% slip. In his study group, Klessinger also identified 16 patients who were diagnosed with spondylolytic spondylolisthesis who were also treated with radiofrequency neurotomy. "The etiology and the mechanisms of pain are different in patients with spondylolytic spondylolisthesis," he noted in his poster presentation. "Patients are younger; there are less degenerative changes and seldom a spinal stenosis." "However, our number of patients with this condition were small, so more research will be required to determine how effective this treatment may be," he added. Klessinger and Cartia had no disclosures.

Primary source: American Academy of Pain Medicine Source reference: Klessinger S, "Radiofrequency neurotomy for conservative management of lumbar spondylolisthesis" AAPM 2011.