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 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: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.

Introduction Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice. Objective This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain. Methods An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated. Results A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure. Conclusion The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness.

BackgroundLumbar radiofrequency neurotomy (LRFN) effectively alleviates zygapophyseal joint-mediated pain by coagulating medial branch nerves to disrupt nociceptive signaling pathways. The concomitant denervation of multifidus fibers has led to concern that LRFN may increase segmental instability and accelerate degenerative changes in patients with certain pre-existing spinal pathologies. There is a paucity of literature evaluating whether LRFN increases the progression of spinal curvature in patients with adult scoliosis.ObjectiveCompare the lumbosacral Cobb angle progression rate in patients with adult scoliosis who underwent LRFN to the annual progression rate of 0.83 ± 1.1° expected by natural history.DesignCross-sectional study.MethodsConsecutive patients diagnosed with adult scoliosis who underwent LRFN to treat zygapophyseal joint-related low back pain were identified. Patient demographics, LRFN procedure details, and radiographs confirming scoliosis were collected from electronic medical records. Pre- and post-LRFN radiographs were used to calculate the average annual rate of Cobb angle progression. Data were analyzed using a Wilcoxon signed-rank test and a linear regression model.ResultsSixty patients (mean age 69.2 ± 11.6 years; 70.0 % female) met the criteria and were included in the analyses. The mean time to radiographic follow-up was 35.0 ± 22.7 months post-LRFN. The average Cobb angle progression was 0.54 ± 3.03° per year and did not differ significantly from the known natural progression rate of 0.83 ± 1.1° per year. None of the included covariates (body mass index, LRFN laterality, and number of levels denervated) were significantly associated with the average annual Cobb angle progression rate.ConclusionsOur results suggest that LRFN has no appreciable effect on the rate of Cobb angle progression in patients with adult scoliosis.

Background Previous study of spinal neurotomy procedures indicates that stringent block selection improves outcomes. However, this pattern is not established for sacral lateral branch radiofrequency neurotomy (SLBRFN). Few SLBRFN studies have used stringent block selection criteria such as ≥80 % pain reduction following dual sacral lateral branch blocks (SLBB). Objective Evaluate the effectiveness of SLBRFN in patients with ≥80 % pain relief following dual SLBBs. Methods Retrospective single-arm cohort study of consecutive patients from two Canadian musculoskeletal and pain clinics who underwent first-time SLBRFN after report of ≥80 % pain relief following dual diagnostic SLBBs. Patients were identified by electronic medical record query between 2016 and 2022. The primary outcome was the proportion of individuals with a ≥50 % reduction in the numeric pain rating scale (NPRS) score three months after SLBRFN. Secondary outcomes included the proportion of responders achieving the minimal clinically important difference (MCID) on the pain disability quality-of-life questionnaire (PDQQ), and the duration and mean percentage of pain relief among those with recurrent symptoms after a successful SLBRFN. Results Of the 70 participants included, 32 (45.7 %; 95 % CI = 34.6–57.3) reported a ≥50 % reduction in NPRS, and 35 (50.0 %; 95 % CI = 38.6–61.4) achieved the MCID on the PDQQ at 3-months. Among the 17 patients who reported a return of symptoms, the mean duration of relief was 8.0 ± 3.5 months, and the mean percentage of pain relief was 77.9 % ± 16.4 %. Logistic regression models revealed that the use of multi-tined RF probes and lower patient BMI were associated with treatment success. Discussion/conclusion SLBRFN reduced pain and disability in approximately 50 % of patients at 3 months when selected using relatively restrictive selection criteria. Treatment success was associated with multi-tined RF probe type and lower patient BMI. Larger prospective studies assessing long-term outcomes are needed to further evaluate the impact of different selection criteria and techniques on SLBRFN effectiveness.

OBJECTIVE:Determine the effectiveness of intradiscal corticosteroid injection (IDCI) for the treatment of discovertebral low back pain. DESIGN:Systematic review. POPULATION:Adults with chronic low back pain attributed to disc or vertebral end plate pain, as evidenced by positive provocation discography or Modic 1 or 2 changes on magnetic resonance imaging. INTERVENTION:Fluoroscopically guided or computed tomography-guided IDCI. COMPARISON:Sham/placebo procedure including intradiscal saline, anesthetic, discography alone, or other active treatment. OUTCOMES:Reduction in chronic low back pain reported on a visual analog scale or numeric rating scale and reduction in disability reported by a validated scale such as the Oswestry Disability Index. METHODS:Four reviewers independently assessed articles published before January 31, 2023, in Medline, Embase, CENTRAL, and CINAHL. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The risk of bias in randomized trials was evaluated with the Cochrane Risk of Bias tool (version 2). RESULTS:Of the 7806 unique records screened, 6 randomized controlled trials featuring 603 total participants ultimately met the inclusion criteria. In multiple randomized controlled trials, IDCI was found to reduce pain and disability for 1-6 months in those with Modic 1 and 2 changes but not in those selected by provocation discography. CONCLUSION:According to GRADE, there is low-quality evidence that IDCI reduces pain and disability for up to 6 months in individuals with chronic discovertebral low back pain as evidenced by Modic 1 and 2 changes but not in individuals selected by provocation discography. STUDY REGISTRATION:PROSPERO (CRD42021287421).

In this Pro-Con commentary article, the Pro side advocates that using the loss of resistance (LOR) to air technique for interlaminar epidural access is safe as the risk of pneumocephalus is exceptionally low. They note that case reports detailing complications typically utilize at least 1 mL of air, frequently exceeding this amount. Even a 1-mL dosage surpasses the requirement, particularly when fluoroscopy is applied in the context of chronic pain management. The proponents also suggest a modified technique, where a syringe containing a drop of saline or contrast acts as a visual cue, minimizing air injection into the epidural space to a negligible quantity. Moreover, they emphasize that air facilitates the identification of any fluid as an indicator of unintended intrathecal access. The Con perspective argues against the utilization of air for epidural access and advocates for the use of LOR with saline instead. This stance is supported by evidence pointing to a greater occurrence of adverse events, such as postdural puncture headache (PDPH) and pneumocephalus, associated with LOR to air compared to LOR with saline. They also argue that saline’s physical properties enhance tactile feedback, potentially contributing to its increased safety. Both saline and air have been used for many years for epidural access via the interlaminar approach. Although both are generally accepted in practice, neither has been formally established as the standard of care. It would benefit the medical community to further delineate the pros and cons of each medium, enabling practitioners to make more informed decisions. This Pro-Con debate will provide 2 perspectives (Table) on the evidence and rationales for the use of air or saline for the LOR technique in interlaminar epidural access with fluoroscopy.

BACKGROUND:Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard. OBJECTIVE:To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard. METHODS:Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3 months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN. RESULTS:USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P > .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable. CONCLUSIONS:This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

Introduction:Lumbar medial branch (MB) radiofrequency ablation (RFA) is a common image-guided procedure to treat facetogenic low back pain. Recent anatomical literature has proposed a two-lesion RFA approach targeting the posterior portion of the lateral neck of superior articular process (SAP) and the superior aspect of the sub-mammillary fossa. The objectives of this report were to: 1) describe the novel lumbar MB RFA technique, 2) discuss the relevant anatomy, and 3) report pain relief outcomes in four patients who gave informed consent to be treated with the novel two-landmark lumbar MB RFA technique. Methods:Four patients were treated with the novel two-landmark lumbar MB RFA technique targeting the posterior half of the lateral neck of SAP and superior aspect of the sub-mammillary fossa. The quality and duration of pain relief following the treatment are described in this report. Results:All 4 patients, who received the novel technique, self-reported quality of pain relief of ≥80 %. One patient, who self-reported 100 % pain relief, elected not to have repeat RFA treatment at their 15-month follow-up appointment. All 4 patients reported pain relief duration ≥12 months and stated the quality of pain relief following procedure was "excellent" or the "best result" they experienced. Conclusions:This case series reports early evidence of the effectiveness of the two-landmark lumbar MB RFA technique. The novel approach shows promise in a limited number of patient cases and warrants further investigation.

Background Given the high prevalence of chronic shoulder pain and encouraging early results of terminal sensory articular branch radiofrequency ablation to treat shoulder pain, research is warranted to refine the procedural technique on the basis of updated neuroanatomic knowledge with the goal of further improving patient outcomes.Objective We describe an updated radiofrequency ablation protocol that accounts for varied locations of the terminal sensory articular branches of the suprascapular, axillary, subscapular, and lateral pectoral nerves within individual patients.Design Technical note.Methods Cadaveric studies delineating the sensory innervation of the shoulder joint were reviewed, and a more comprehensive radiofrequency ablation protocol is proposed relative to historical descriptions.Conclusions The proposed radiofrequency ablation protocol, which is based on neuroanatomic dissections of the shoulder joint, will provide a safe means of more complete sensory denervation and potentially improve clinical outcomes compared with historical descriptions, the efficacy of the new protocol must be confirmed in prospective studies.

INTRO:Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain related to osteoarthritis. It is often utilized when conservative management has failed and patients wish to avoid arthroplasty, are poor surgical candidates due to comorbid medical conditions, or in those suffering from persistent pain after arthroplasty. The classic targets for GNRFA include the superior lateral genicular nerve, superior medial genicular nerve, and inferior medial genicular nerve but multiple anatomic studies have demonstrated additional sensory innervation to the knee. OBJECTIVE:In this research article, we propose an image-guided technique that can safely target the infrapatellar branch of the saphenous nerve which also provides sensory innervation to the anterior capsule. PROPOSAL:The proposed technique includes variations for conventional bipolar radiofrequency ablation, cooled radiofrequency ablation, dual-tined bipolar radiofrequency ablation, and monopolar radiofrequency ablation using a long axis approach. The described technique is based on updated anatomic studies and takes into account safety concerns such as thermal risk to the skin and/or pes anserine tendons and breaching of the synovial cavity. CONCLUSION:Future clinical research should be performed to confirm the safety and effectiveness of this specific approach.

BACKGROUND:Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain. However, there has been minimal investigation of real-world, long-term outcomes and factors that predict treatment success after GNRFA. OBJECTIVES:To evaluate the effectiveness of GNRFA for chronic knee pain in a real-world population and identify predictive factors. METHODS:Consecutive patients who underwent GNRFA at a tertiary academic center were identified. Demographic, clinical, and procedural characteristics were collected from the medical record. Outcome data were numeric rating scale (NRS) pain reduction and Patient Global Impression of Change (PGIC). Data were collected by standardized telephone survey. Predictors of success were evaluated with logistic and Poisson regression analyses. RESULTS:Of the 226 total patients identified, 134 (65.6 ± 12.7; 59.7% female) were successfully contacted and analyzed, with a mean follow-up time of 23.3 ± 11.0 months. Of those, 47.8% (n = 64; 95% CI: 39.5%-56.2%) and 61.2% (n = 82; 95% CI: 52.7%-69.0%) reported ≥50% NRS score reduction and ≥2-point NRS score reduction, respectively, and 59.0% (n = 79; 95% CI: 50.5%-66.9%) reported "much improved" on the PGIC questionnaire. Factors associated with a greater likelihood of treatment success (P < .05) were higher Kellgren-Lawrence osteoarthritis grade (2-4 vs 0-1); no baseline opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted. CONCLUSION:In this real-world cohort, approximately half of the participants experienced clinically meaningful improvements in knee pain after GNRFA at an average follow-up time of nearly 2 years. Factors associated with higher likelihood of treatment success were more advanced osteoarthritis (Kellgren-Lawrence Grade 2-4); no opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.

Introduction:Multiple factors (patient age, wait time, depression, etc.) have been associated with lower patient satisfaction as assessed by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Social deprivation has been shown to impact multiple aspects of patient care but its impact on patient satisfaction in Physical Medicine and Rehabilitation (PM&R) is limited. Objective:We hypothesized that increased social deprivation would independently predict lower patient satisfaction, as measured by the PGOMPS. Design:Retrospective large cohort study. Setting:Single tertiary academic institution. Patients:Adult patients seen by PM&R physicians practicing outpatient interventional spine and musculoskeletal medicine who completed PGOMPS between January 1, 2014 and December 31, 2019. Interventions:Independent variables include: Social deprivation as measured by 2015 Area Deprivation Index (ADI), wait time, patient age, and sex. Main outcome measure:Patient satisfaction was defined as receiving a perfect PGOMPS Total Score. Results:A totla of 64,875 patients (mean age 52.7 ± 21.8 years, 41.4% male, mean ADI 29.9 ± 18.8) were included. Univariate analysis showed a decreased odds of achieving satisfaction for each decile increase in ADI (odds ratio 0.965; 95% confidence interval 0.957-0.973; p < 0.001). The most socially deprived quartile was significantly less likely to report satisfaction on PGOMPS compared to the least deprived quartile (91.1 vs 93.2; p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction was 0.99 (95% confidence interval 0.980 to 0.997; p = 0.009) for the Total Score, independent of age, wait time, and patient sex for each decile increase in ADI. Conclusions:In this cohort, increased social deprivation independently predicted patient dissatisfaction in PM&R.

BackgroundGenicular radiofrequency neurotomy (GRFN) is an effective treatment for a subset of individuals with chronic knee pain. Previous studies demonstrate that Medicare and Medicaid beneficiaries report worse outcomes following various interventional procedures compared with commercially insured patients.ObjectiveEvaluate the association of payer type on GRFN treatment outcomes.MethodsConsecutive patients who underwent GRFN at a tertiary academic center were contacted for participation. Demographic, clinical, and procedural characteristics were collected from electronic medical records. Outcome data were collected by standardized telephone survey at 6–12 months, 12–24 months and ≥24 months. Treatment success was defined as ≥50% numerical pain rating scale (NPRS) score reduction from baseline. Data were analyzed using descriptive statistics for demographic, clinical, and procedural characteristics. Logistic and Poisson regression analyses were performed to examine the association of variables of interest and pain reduction.ResultsOne hundred thirty-four patients treated with GRFN (mean 65.6 ± 12.7 years of age, 59.7% female) with a mean follow-up time of 23.3 ± 11.3 months were included. Payer type composition was 48.5% commercial (n = 65), 45.5% Medicare (n = 61), 3.7% Medicaid (n = 5), 1.5% government (n = 2), and 0.8% self-pay (n = 1). Overall, 47.8% of patients (n = 64) reported ≥50% NPRS score reduction after GRFN. After adjusting for age, follow-up duration, Kellgren-Lawrence osteoarthritis grade, baseline opioid use, antidepressant/antianxiety medication use, history of knee replacement, and number of RFN lesions placed, the logistic regression model showed no statically significant association between payer type and treatment outcome (OR = 2.11; 95% CI = 0.87, 5.11; p = 0.098).Discussion/conclusionIn this study, after adjusting for demographic, clinical, and procedural characteristics, we found no association between payer type and treatment success following GRFN. This observation contrasts findings from other interventional studies reporting an association between payer category and treatment success.

Background:Lumbar radiofrequency neurotomy (LRFN) effectively treats lumbar zygapophyseal joint pain by coagulating medial branch nerves (MBNs) carrying nociceptive signals. MBNs also innervate deep paraspinal muscles. There is a paucity of literature on whether LRFN accelerates the progression of vertebral displacement in patients with degenerative lumbar spondylolisthesis (DLS). Objective:Compare the rate of spondylolisthesis progression in adults with DLS who underwent LRFN to the 2% annual rate of progression expected by natural history. Design:Cross-sectional cohort study. Methods:Consecutive patients with pre-existing DLS who underwent LRFN for zygapophyseal joint-mediated low back pain were identified. Patient demographics, LRFN procedure details, and radiographic images confirming Meyerding Grade (I-II) spondylolisthesis were collected from electronic medical records. The quantitative magnitude of spondylolisthesis progression and the annualized rate were calculated from pre-and post-LRFN radiographs. Data were analyzed using Wilcoxon signed-rank tests and a linear regression model. Results:152 patients (mean age 65.9 ± 12.3 years; 59.2% female) met eligibility criteria and were included in the analyses. Average time to radiographic follow-up was 35.6 ± 24.7 months post-LRFN. The average spondylolisthesis progression rate of 1.63 ± 2.91% per year calculated for the LRFN cohort was significantly lower than the 2% annual rate of progression associated with natural history (p < 0.001). None of the included covariates, such as age, BMI, LRFN laterality, number of levels denervated, or history of prior lumbar spinal surgery, were significantly associated with the average annual rate of progression. Conclusions:Our results suggest that spondylolisthesis progression rate is no different or worse than the expected natural progression rate in patients with pre-existing DLS who have undergone LRFN.