A comparison of the effectiveness of cervical medial branch radiofrequency ablation for chronic facet joint syndrome in patients selected by two common medial branch block paradigms.

Background: Cervical medial branch radiofrequency ablation (CMBRFA) is effective when patients are selected by dual medial branch blocks (MBBs). SIS guidelines recommend 100% pain improvement after dual comparative MBBs before CMBRFA; however, our prior investigation showed similar outcomes in those selected by a lesser strict paradigm. Objective: Compare pain and patient impression of improvement after CMBRFA in individuals stratified by a less stringent (80-99%) dual MBB response than those selected by the 100% criteria. Design: Cross-sectional study. Methods: Follow-up was conducted via standardized telephone survey at ≥6 months post-CMBRFA to obtain Numerical Rating Scale (NRS) pain and Patient Global Impression of Change (PGIC) scores. Primary and secondary outcomes were within-group and between-group differences in the proportions of patients reporting ≥50% NRS score reduction and PGIC scores. Results: Medical records of 195 consecutive patients were reviewed; 100 individuals were analyzed. 48% (95% CI 35-61%) and 52% (95% CI 37-67%) of the 80-99% and 100% MBB groups, reported ≥50% pain reduction at ≥6 months post-CMBRFA. 74% (95% CI 63-85%) and 67% (95% CI 52-81%) of the 80-99% and 100% MBB groups reported a PGIC score consistent with "improved" or "very much improved." There were no significant between-group differences in any outcome at any time point. Conclusions: We observed similar rates of pain relief and global improvement after CMBRFA in patients selected by dual MBBs with ≥80% symptom relief versus 100% relief. This provides evidence that a more practical criteria, compared to a more strict selection paradigm, may result in similar clinical outcomes.