Radiofrequency lesioning of the L2 ramus communicans in managing discogenic low back pain.

BACKGROUND Discogenic low back pain is a common cause of chronic low back pain that remains a treatment challenge. The innervation and transmission of nociceptive information from painful lumbar discs has only recently been better described. OBJECTIVE To report initial experience of effectiveness of radiofrequency lesioning of L2 ramus communicans in managing discogenic pain. STUDY DESIGN A prospective, case series. METHODS A case series of 5 patients who had radiofrequency lesioning of the ramus communicans at the L2 level. All patients had discogenic low back pain and had diagnostic blocks with local anesthetic at the level of the L2 ramus communicans demonstrating significant pain relief. Continuous radiofrequency lesioning at 80 degrees C of the L2 ramus communicans for 60 seconds was performed. Standard outcome measures of reduction in the visual analogue scale (VAS), improvement in function, reduction in pain medication, and consistent improvement in low back pain with repeating of the procedure after its initial effect has worn off were recorded. RESULTS All five patients had consistent pain relief after a minimum of 2 radiofrequency lesioning treatments approximately 4 months apart. Four of the five patients had a reduction in pain medication, and all reported improvement in sitting tolerance and functioning. There were no side effects or complications. CONCLUSION Radiofrequency lesioning of the L2 ramus communicans seems to offer partial relief for patients suffering from discogenic pain. Further studies are needed to confirm our results.