Combined Thoracic Medial Branch Radiofrequency and Chemical Neurotomy

ObjectiveExplore the effectiveness of thoracic medial branch neurotomy (MBN) using combined radiofrequency neurotomy and neurolytic lesioning.DesignA retrospective cohort of consecutive patients with chronic thoracic axial pain treated in a community setting.InterventionsWe included all patients who underwent MBN between 2010 and 2016, selected for MBN primarily based on 70% relief following single or dual diagnostic medial branch blocks. Using 18-gauge cannulas, we placed electrodes and made lesions at the suspected location of the thoracic medial branch based on anatomic knowledge at the time; the thermal lesions were supplemented with 50% dextrose to enhance the lesion radius.MeasuresWe defined success as ≥50% relief of their index thoracic pain not returning to baseline for at least six months. Patients not reached for follow-up were considered failures for worst-case analysis.ResultsTwenty-eight patients underwent an initial MBN between 2010 and 2016: Twenty-five of twenty-eight (89%) patients reported ≥70% pain reduction not returning to baseline for six months or longer. Using a worst-case analysis (WCA), patients reported average pain relief of 73% CI (63%,84%) with a mean duration of relief following the initial MBN of 9.9 months CI (6, 13.5). Seventeen of the initial 28 patients had a total of 31 repeat MBNs, 13/17 (76%) having pain relief reinstated after one or more repeat MBNs with an average duration of relief following a first repeat MBNs of 10.9 months CI (6.6,15.2).ConclusionThoracic MBN combined with a mild neurolytic is a potentially effective treatment for thoracic pain in patients selected with positive diagnostic MBB. There were no complications noted. One can reinstate pain relief with repeated MBN in most patients should their symptoms return.