Safety and Efficacy of Lumbar Spine Radiofrequency Neurotomy in the Presence of Posterior Pedicle Screws

Objective: To determine the safety and the efficacy of lumbar spine radiofrequency neurotomy performed in the presence of pedicle screws in patients with chronic low back pain. Methos: Retrospective practice audit. Review of charts of all patients who underwent lumbar radiofrequency neurotomy in the presence of pedicle screws. Patients were tested with a minimum of two controlled medial branch blocks and treated with radiofrequency neurotomy. A successful outcome was defined as at least 50% pain reduction for a minimum of three month. Results: Thirty eight patients were identified with pedicle screws present at the time of the neurotomy. No adverse effects were observed and no patients reported a worsening of the pain after RFN. No clinical effect related from heating of the metal devices was observed. A pain reduction of at least 50% for a minimum of three months was achieved in 20 patients (52.6%). Pain in the index segments and also in adjacent segments was treated with no difference in success. Conclusion: Some 50% of the patients with pedicle screws benefits from radiofrequency neurotomy for about six months. This potential benefit for the patient must be offset against the risk of the procedure, which might be higher because of the increase in temperature of the metal devices. Still, no adverse effects were observed. Selection of treatment level and positioning the electrode next to the pedicle screws are challenging.