Summary of background data:Lumbar medial branch radiofrequency ablation (LMBRFA) is an effective treatment for facet joint pain. LMBRFA efficacy was originally demonstrated using a parallel technique. Newly developed RFA probes (e.g., Trident) allow a perpendicular approach (P-LMBRFA), which may simplify the RFA technique and lead to superior treatment success rates. However, further investigation is necessary to determine whether these technologies are associated with improved patient outcomes. Objectives:Evaluate the effectiveness of P-LMBRFA in patients with confirmed facet pain. Methods:In this retrospective single-arm cohort study, electronic medical records were used to identify consecutive patients with ≥80 % dual medial branch block-confirmed pain relief who underwent first-time P-LMBRFA between 2016 and 2022. Primary outcomes were ≥50 % Numerical Rating Scale (NRS) pain improvement and the minimal clinically important difference (MCID) on the Pain Disability Quality-of-Life Questionnaire (PDQQ) at 3 months post-treatment. Secondary outcomes included the duration and mean retrospective percentage of pain relief after a successful index P-LMBRFA in individuals who reported a return of their index symptoms. Results:174 participants (60.3 % female, 61.3 ± 14.2 years of age, BMI 29.5 ± 6.7 kg/m2) were analyzed. Success rates for ≥50 % NRS reduction and MCID on the PDQQ at 3 months were 50.6 % (95 % CI = 43.3-57.9 %) and 50.0 % (95 % CI = 42.8-57.2 %), respectively. Of the 88 successful P-LMBRFAs, 60 patients experienced a return of symptoms after 8.7 ± 3.6 months and reported a retrospective mean percentage pain relief of 81.8 % ± 15.8 %. Discussion/conclusion:Following P-LMBRFA, approximately 50 % of patients reported improvement in pain and disability measures. Extensive, prospective research comparing long-term outcomes of P-LMBRFA and parallel LMRBFA is warranted.

OBJECTIVE:To evaluate the effectiveness of genicular nerve radiofrequency ablation (GnRFA) for chronic knee pain due to osteoarthritis or persistent post-surgical knee pain (PPSP). METHODS:Population: Adults ≥ 18 years with chronic knee pain due to osteoarthritis (OA) or PPSP. Intervention: GnRFA. Comparison: Sham, placebo, active treatments, or no comparator. Outcomes: Proportion of individuals with pain score reductions of ≥ 50% or ≥ 2 points or ≥ 30% improvement in functional measures at 1, 3, 6, 12, 18, and 24 months. Search Strategy and Risk of Bias Assessment: Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched through April 2024 (PROSPERO ID CRD42024552068). Cochrane Risk of Bias 2, Risk of Bias In Non-Randomized Studies-of Interventions and National Heart, Lung, and Blood Institute quality assessment tools were used accordingly. RESULTS:The search identified 1,849 records, with 226 full-texts reviewed and 28 studies included (11 randomized controlled trials and 17 observational studies, totaling 2,218 participants). Pooled success rates for ≥50% pain reduction in both OA and PPSP were 51% (95% CI : 49-54%) at 6 months, 43% (95% CI : 40-47%) at 12 months, and 58% (95% CI : 48-67%) at 24 months. Large lesions showed higher pooled success rates compared to small lesions at 12 months (55% (95%CI : 51-59%) vs. 34% (95%CI : 26-43%)). CONCLUSIONS:GnRFA is effective in reducing knee pain in the majority of patients with osteoarthritis when large lesion techniques are used with moderate-certainty evidence, according to GRADE. Alternatively, there is low quality evidence that GnRFA results in treatment benefit for individuals with PPSP. These conclusions, however, are limited by small subgroup sample sizes and the lack of a meta-analysis.

BACKGROUND CONTEXT Clinical trials have demonstrated the efficacy and effectiveness of interosseous basivertebral nerve radiofrequency ablation (BVNA) for treating vertebrogenic chronic low back pain (vLBP). However, substantially fewer studies have evaluated the effectiveness of this treatment in a real-world population. PURPOSE Evaluate the effectiveness of BVNA as treatment for vLBP, including patients with dominant vLBP versus vLBP with concomitant pain sources. STUDY DESIGN/SETTING Single-arm prospective cohort study. PATIENT SAMPLE Patients aged 32-79 years with LBP of ≥ 6 months duration accompanied by Type 1 or 2 Modic changes on MRI. OUTCOME MEASURES The primary outcome was mean improvement in Oswestry Disability Index (ODI) score at 3-months post BVNA. Secondary outcomes included the proportion of participants with (1) ≥30% and ≥15-point ODI improvements, (2) ≥2-point and ≥50% reductions in Numerical Rating Scale (NRS), (3) at least “much improved” on Patient Global Impression of Change (PGIC), and (4) opioid utilization at 3- and 12-month follow-up. METHODS Patients who received BVNA from 2020-2023 at a single tertiary academic center were approached for participation. Demographic and procedural data were collected from electronic medical records and baseline study visits, with outcomes assessed via telephone follow-up. Participants were categorized as having dominant vLBP versus multifactorial low back pain (mLBP) that necessarily included vLBP. RESULTS A total of 60 participants were included (mean age 57.0±13.4 years; 45% female): 16 (26.7%) had dominant vLBP, while 44 (73.3%) had mLBP. Mean ODI score improvement was 13.9±18.7 and 14.0±15.7 points at 3- and 12-month follow-up, respectively, with average improvements of 15.1±18.2 and 13.6±14.9 points for the dominant vLBP and mLBP subgroups at 12 months. At 12-months, 52.8% (95%CI: 39.7-65.6) of participants reported >30% improvement in ODI, including 57.1% (95%CI: 32.6-78.6) with dominant vLBP and 51.3% [95%CI: 36.2-66.1] with mLBP). At 12-months, The proportion 39.6% (95%CI: 27.6-53.1) of participants achieved a ≥15-point improvement in ODI, including 42.9% (95%CI: 21.4-67.4) with dominant vLBP and 38.5% [95%CI: 24.9-54.1] with mLBP). 12-month responder rates for >2-point and ≥50% NRS improvement were 67.9% (95%CI: 54.5-78.9) and 49.1% (95%CI: 36.1-62.1) overall, 50.0% (95%CI: 26.8-73.2) and 50.0% (95%CI: 26.8-73.2) for the dominant vLBP group, and 74.4% (95%CI: 58.9-85.4) and 48.7% (95%CI: 33.9-63.8) for the mLBP group. The proportion of participants who reported “much or very much improved” on PGIC at 12 months was 54.7% (95%CI: 41.5-67.3) overall (71.4% [95%CI: 45.4-88.3] dominant vLBP vs 48.7% [95%CI: 33.9-63.8] mLBP). At baseline, 36.7% (95%CI: 25.6-49.3) of participants reported active opioid use (25.0% [95%CI: 10.2-49.5] with dominant vLBP versus 40.9% [95%CI: 27.7-55.6] with mLBP). At 12-months, 34.0% (95%CI: 22.7-47.4) reported active opioid use, (35.7% [95%CI: 16.3-61.2] with dominant vLBP versus 33.3% [95%CI: 20.6-49.0] with mLBP). CONCLUSIONS In this real-world cohort, over half of participants with vLBP experienced clinically meaningful improvements in pain and function at 12-month post-BVNA. While no intergroup differences achieved statistical significance, responder rates for ODI and PGIC were higher among the dominant vLBP group compared to those with mLBP in this cohort. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

Background:Thoracic medial branch radiofrequency neurotomy (TMBRFN) is used to treat chronic thoracic facet joint pain, but research on its technique and effectiveness is still needed. The current International Pain and Spine Intervention Society Practice Guidelines do not describe a technique for TMBRFN. Objectives:Evaluate the effectiveness of TMBRFN in patients with thoracic facet joint pain. Methods:Single-arm, retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time TMBRFN between 2016 and 2022. The primary outcome was the proportion of patients with ≥50 % reduction in numerical rating scale (NRS) pain score at 3-months post-procedure. Secondary outcomes included the proportion of patients who achieved a ≥17-point reduction on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3-months, as well as mean patient-reported percentage pain relief and duration of relief after a successful index TMBRFN in individuals who reported a return of their index symptoms. Results:18 consecutive patients (50.0 % male; mean age 60.9 ± 15.3 years; mean BMI 30.3 ± 6.9 kg/m2) were analyzed. At 3 months post-procedure, 10 patients (55.6 % [95%CI 33.7-75.4]) reported ≥50 % NRS pain reduction and 9 (50.0 % [95%CI 29.0-71.0]) reported ≥17-point PDQQ-S reduction. Of the 10 patients with successful treatment responses, 4 had a return of symptoms after an average of 9.3 ± 2.2 months with a reported retrospective mean percentage pain relief of 70.0 ± 34.6 %. Conclusion:Within this cohort, approximately 60 % of patients experienced improvement in pain and disability at 3 months following TMBRFN. Among patients whose index symptoms returned after successful treatment, the average reported pain relief was 70 % for close to 9 months. Larger, prospective studies with long-term outcomes are needed to better elucidate the safety and effectiveness of TMBRFN.

Objective Evaluate the effectiveness of genicular nerve radiofrequency ablation (GNRFA) for chronic knee pain using the Patient-Reported Outcomes Measurement Information System Global Health, Physical Health score (PROMIS-GH-PH). Methods Patients who underwent GNRFA at a tertiary academic center were identified by CPT code query and contacted for consent. Demographic, clinical, and procedural characteristics were collected from the electronic medical record of participants with baseline PROMIS-GH-PH scores. Outcome data were collected by standardized telephone survey. Treatment success was defined as a ≥2.3-point improvement in PROMIS-GH-PH score (the minimal clinically important difference [MCID]). Predictor variables of PROMIS score change were evaluated using univariate and multivariate linear regression analyses. Results 32 patients (65.6 % female; 63.7 ± 10.7 years of age) met eligibility criteria and consented to be included in the study. In this cohort, 56.3 % (18/32; 95 % CI: 37.7–73.6) of patients reported improvement ≥ MCID on PROMIS-GH-PH at a mean follow-up time of 21.5 ± 10.6 months. Linear regression analysis demonstrated that patients who never smoked and those with a Kellgren-Lawrence (KL) osteoarthritis grade of 4 had significantly greater PROMIS-GH-PH score improvements at follow-up compared to current or former smokers and patients with KL grades of 0–3, respectively. Conclusion In this real-world cross-sectional cohort study, over 56 % of participants experienced improvment ≥ MCID on PROMIS-GH-PH after undergoing GFRNA for chronic knee pain. Non-smoking status and radiographically severe osteoarthritis were associated with greater PROMIS-GH-PH score improvements from baseline.

Background:Dorsal root ganglion (DRG) stimulation has emerged as an effective, targeted neuromodulation therapy for refractory pain of the lower extremities, particularly in the setting of complex regional pain syndrome. However, preliminary evidence supporting DRG for other applications, such as peripheral neuropathy or refractory nociceptive pain, is currently limited to patient populations with discrete pain sources. We report a case of chronic, multifactorial foot pain successfully treated with a right S1 DRG stimulation after failure of multiple prior interventions including physical therapy, corticosteroid injections, and surgeries. Case report:A 74-year-old male presented with chronic refractory right foot pain, diagnosed with L5-S1 radiculopathy, peripheral neuropathy, persistent post-surgical pain following multiple procedures, including partial toe pain, which significantly impaired his mobility and quality of life. DRG stimulation was pursued after multiple prior interventions, including physical therapy, corticosteroid injections, surgeries, and a trial of peripheral nerve stimulation (PNS) that provided only temporary relief. Following a successful stimulation trial, a permanent DRG device was implanted at the S1 level, resulting in meaningful, sustained pain relief and functional improvement. Conclusion:DRG stimulation represents a promising treatment for refractory lower extremity pain, especially in cases where traditional therapies have failed. This case illustrates its therapeutic potential in patients with complex refractory neuropathic pain of mixed etiologies.

Background:Cervical medial branch radiofrequency neurotomy (CMBRFN) with a parallel approach has been proven to be an effective treatment for zygapophyseal joint-mediated cervical pain. Technological advancements in radiofrequency probe design have allowed for a perpendicular approach to electrode placement. However, the effectiveness of the perpendicular approach remains to be fully understood. Objectives:Evaluate the effectiveness of CMBRFN with a perpendicular approach (pCMBRFN) in patients with confirmed zygapophyseal joint-mediated cervical pain. Methods:This single-arm, retrospective cohort study included patients identified between 2016 and 2022 who underwent pCMBRFN after demonstrating ≥80 % pain relief with two consecutive diagnostic medial branch blocks (MBB). Primary outcomes were ≥50 % patient-reported numeric rating scale (NRS) pain relief and minimal clinically important difference (MCID) on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3 months post-procedure. Secondary outcomes were mean patient-reported retrospective percentage pain relief and duration of relief after a successful pCMBRFN in individuals who presented for repeat pCMBRFN upon return of their symptoms. Results:A total of 52 participants (63.5 % female; mean age 55.9 ± 10.9 years; mean BMI 26.8 ± 5.2 kg/m2) were analyzed. At 3 months post-procedure, ≥50 % NRS pain reduction and MCID on PDQQ-S were both reported by 34 patients (65.4 % [95%CI 51.8-76.9]). Of the 34 patients with successful treatment response, 15 had return of symptoms after an average of 8.8 ± 2.5 months with a reported mean percentage pain relief of 86.0 ± 14.9 %. Conclusion:Within this cohort, pCMBRFN demonstrated effectiveness by reducing pain and disability in over 65 % of patients with confirmed cervical zygapophyseal joint-mediated pain at 3 months. Patients with successful treatment outcomes whose index symptoms eventually returned reported an average pain reduction of 86 % lasting approximately 9 months. Larger prospective studies with long-term follow-up are needed to confirm these results.

BACKGROUND:The effectiveness and safety of intraosseous basivertebral nerve ablation (BVNA) for treating vertebrogenic pain is established, but low back pain-related healthcare utilization (LBPr-HU) following BVNA continues to be defined. METHODS:LBPr-HU data were pooled from 3 prospective studies. LBPr-HU categories of interest included non-invasive conservative care, opioid utilization, lumbosacral spinal injection (LSI), lumbosacral radiofrequency ablation (LRFA), and lumbosacral spinal surgery. Pre- and post-BVNA LBPr-HU were compared at both 1- and 5-years using McNemar's test for proportions and paired t-tests for means. RESULTS:Two hundred forty-seven patients received BVNA and had 1-year follow-up; 205 had long-term follow-up (mean of 5.3 ± 1.33 years). Twenty-seven percent fewer participants initiated conservative care in the year post-BVNA compared to the year preceding BVNA (P < .001; 95% CI 19.8-34.5). Of 77/247 participants taking opioids at baseline, 40.3% and 61.7% fewer were taking them at one-year and 5.3 ± 1.33 years post-BVNA, respectively (P < .001). Of participants receiving LSIs in the year preceding BVNA, 81.2% fewer received LSI(s) in the year post-BVNA (P < .001; 95% CI 70.7-90.7); a 76.4% reduction in LSIs was maintained through a mean of 5.3 ± 1.33 years post-BVNA. LRFA rates were 1.6% at 1-year post-BVNA and 8.3% at 5.3 ± 1.33 years post-BVNA. Lumbar fusion surgery was 0.8% at 1-year post-BVNA and 6.5% at 5.3 ± 1.33 years post-BVNA. CONCLUSIONS:In this aggregate analysis of patients with vertebrogenic pain, utilization of conservative care, opioids, LSIs, and LRFA were substantially reduced through 5 years post-BVNA compared to baseline. Lumbar fusion rates were less than half the published value at 5 years in similar populations.