Pain Medicine

Biography

Biography: Wolfgang Stelzer

Abstract

Background Facet joints and the sacroiliac joint (SIJ) complex have been identified as a common source of chronic low back pain. Low back pain is a commom problem. The prevalence of facet joint (FJ) mediated low back pain is 31% i - 45%ii, the prevalence for the SI Joint as a source of chronic axial low back pain is reported between 18% and 30%iii. Radiofrequency (RF) neurotomy has been investigated in recent years as a minimally invasive treatment option for FJ –and SIJ-mediated low back pain. The use of atestblock as a predictive factor is well documented. Predective co-factors like BMI, gender, and comorbidities for successful and long term pain decrease have not been well established. Objective This retrospective study was designed to illustrate the general outcome after radiofrequency neurotomy of lumbar medial branches and rami posterior of the SI Joint in patients with low back pain 1, 6 and 12 months after treatment. Outcomes were stratified by BMI, gender and age to determine their effect on the reduction of opioids and NSAIDS. Study Design. The records of 164 patients with chronic low back pain who underwent treatment with RF medial branch Neurotomy (parallel needle technique) and/or cooled RF LBN in case of SI Joint mediated low back pain were identified. Subjects were selected for treatment based on physical examination and positive response (>50% pain relief) to an lumbar medial branch block/Ramus dorsalis L5 block or intraarticular SIJ block. Lumbar medial branches L3 and L4 and the ramus dorsalis L5 were lesioned in „ISIS“ parallel needle technique (N=36), Cooled RF LBN involved lesioning the L5 dorsal ramus and lateral to the S1, S2, and S3 posterior sacral foraminal apertures (N=87). Visual analog scale (VAS) pain scores, quality of life, BMI, medication usage, and satisfaction were asked before the procedure, at 1 month postprocedure (N = 164), and again after 6 (N= 75) and 12 months (N=89) postprocedure. Results A VAS decrease in the total group was seen from 8 to 4 after 6 months and 4.5 after 12 months, and lower medication usage (opioids decreased 40%, NSAIDS decreased 60%). Pain decrease can be shown in this study for 12 months. Our data illustrate a significant better outcome for patients with a BMI lower than 30. There is no difference in VAS decrease between male and female. There were no severe or moderate complications during or after all procedures. Conclusion The data may suggest the use of RF treatment in case of low back pain as a proper treatment option as well as the probability of 95% to have a VAS decrease of 3-4 points on a 0-10 scale.Treatment of chronic low back pain with RF modalities is a safe, long term effective, pain reducing treatment option. Public insurance should be encouraged to provide reimbursement for this safe and reliable method of treating low back pain. Key Words Low back pain, Lumbar medial branch and ramus dorsalis L5 Neurotomie, Cooled RF LBN, BMI / Sex Dependence