Technical Description of Cooled Radiofrequency Ablation of Lumbar Medial Branches for the Treatment of Lumbar Facet Pain

Patients of the George Washington Spine and Pain Center

Inclusion Criteria:

1. Literate
2. Aged between 18 and 60 years
3. Chronic lumbar pain for > 6 months
4. 3-day average NRS score at least 4 and not greater than 8
5. Clinical features consistent with possible lumbar z-joint pain (such as pain and tenderness over not more than three segments unilaterally)
6. No adequate relief with conservative management, including physical therapy, chiropractic manipulation, exercises, and drug therapy
7. Understand and tolerate lumbar medial branch diagnostic blocks
8. Positive for lumbar zygapophyseal joint pain after comparative diagnostic blocks (≥ 80% pain relief) per standard of care.
9. Understands study protocol and provides voluntary written consent to participate in study and outcome measurements
10. Normal neurological exam
11. Understands and agrees to use an acceptable form of birth control

Exclusion Criteria:

1. Current pregnancy, currently breast feeding or the intent of becoming pregnant during the study period
2. Prior posterior lumbar fusion
3. Prior low back surgery
4. Concurrent cervical or thoracic pain or pain in these regions lasting longer than 2 weeks during the last 6 months
5. Compensable disability or work injury or ongoing litigation
6. Prior treatment with radiofrequency neurotomy in the lumbar region within 3 months
7. Discogenic pain verified by controlled discography
8. Sources of pain not in the lumbar spine
9. Leg pain greater than back pain
10. Obvious inappropriate pain behavior during physical exam
11. Neurologic deficits
12. Positive straight leg raising result
13. Any features of upper motor neuron lesion
14. Gait abnormality not attributable to spinal pain
15. Severe Central Spinal Canal Stenosis (> 50%) evident on prior computed tomogram or magnetic resonance image
16. Spondylolysis
17. Spondylolisthesis
18. More than 75% narrowing of a disc space on plain radiographs
19. Spondyloarthropathy
20. Score higher than 20 on the Beck Depression Inventory
21. Patients addicted to alcohol, narcotics or other illegal substances
22. Dependence on opioids
23. Uncontrolled acute/chronic illness that may confound interpretation of outcome measures
24. Allergy to injectants, medication or anesthetics to be used
25. Active or uncontrolled rheumatoid arthritis or other autoimmune diseases
26. Patients with a history of mental instability or diagnosed with a mental disorder
27. Patient unwilling or unable to comply with study procedures or follow-up visits
28. The presence of a pacemaker in the patient