Parallel Versus Perpendicular Technique for Lumbar Medial Branch Radiofrequency Neurotomy

  • End date
    Dec 20, 2022
  • participants needed
  • sponsor
    Vanderbilt University Medical Center
Updated on 20 November 2021
back pain
low back pain


Low back pain is a leading cause of disability worldwide. The lumbar zygapophyseal joints (z-joints) are estimated to be the source of low back pain between 10% and 40% of the time. Observational studies have shown that lumbar medial branch radiofrequency neurotomy (LMBRFN) can be an effective treatment for z-joint low back pain. Nonetheless, other publications such as the Cochrane collaboration systematic review and the "Minimal Interventional Treatments for Participants with Chronic Low Back Pain" or "MINT" randomized controlled trial conclude that LMBRFN is not efficacious. These discrepancies in the literature may be due to differences in patient selection and procedural technique. This study aims to employ patient selection via dual medial branch block resulting in at least 80% relief on both occasions. Using this rather strict enrollment criteria, the aim of the study is to then compare LMBRFN utilizing 16 gauge needles via the "parallel" approach as endorsed by Spine Intervention Society guidelines to LMBRFN performed with 22 gauge needles and another commonly employed "perpendicular" technique similar to that approach used for medial branch blocks. The primary outcome of the study will be to determine if there is a difference in the percentage of patients with lumbar facet pain who achieve moderate or good response (improvement of Numeric Pain Rating Scale of at least 50% or 80%) or in the duration of effect (median duration of moderate or good response in those with positive outcome) between these two groups.

Condition Lower Back Pain, Chronic Back Pain, Lumbar Radiofrequency Neurotomy, Back Pain, Low Back Pain, lumbago
Treatment Parallel placement of 16 gauge electrodes, Perpendicular placement with 22 gauge electrodes
Clinical Study IdentifierNCT03912519
SponsorVanderbilt University Medical Center
Last Modified on20 November 2021


Yes No Not Sure

Inclusion Criteria

aged > 40, capable of understanding and providing consent in English, capable of complying with the outcome instruments used, capable of attending all planned follow up visits
unilateral or bilateral low back pain of at least 4/10 on Numeric Pain Rating Scale (NPRS) present for at least 2 months that has failed to adequately respond to at least 6 weeks of physical therapy and oral pain medication
at least 80% improvement on two consecutive lumbar medial branch blocks of no more than a total of 4 lumbar facet joints
beyond the above stated criteria, the decision to initiate the process of a first medial branch block is based on clinical decision making of the treating physician
Patient consents to treatment in a shared decision-making process with the treating physician

Exclusion Criteria

Those whose primary complain is lumbar radiculopathy
Those receiving remuneration for their pain treatment (e.g., disability, worker's compensation)
Those involved in active litigation relevant to their pain
Those unable to read English and complete the assessment instruments
Those unable to attend follow up appointments
The patient is incarcerated
History of prior lumbar fusion
Progressive motor deficit, and/or clinical signs of cauda equina or polyradiculopathy
History of lumbar steroid injection (epidural steroid injection, sacroiliac joint steroid injection, lumbar facet steroid injection) within the prior 3 months
Possible pregnancy or other reason that precludes the use of fluoroscopy
Allergy to contrast media or local anesthetics
Active Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis, lupus)
Active infection or treatment of infection with antibiotics within the past 7 days
Medical conditions causing significant functional disability (e.g., stroke, COPD)
Chronic widespread pain or somatoform disorder (e.g. fibromyalgia)
Addictive behavior, severe clinical depression, or psychotic features
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