August 2019 Edition. Volume XIX

Once it had been well demonstrated that lumbar RF facet blocks were an important technique in the field of minimally invasive spine care it was reasonable to expect that this approach would also be of value in the treatment of zygoapophyseal dysfunctional problems in the thoracic and cervical areas.  In 1996 Dr. Susan Lord and associates from Newcastle, Australia published on their work in treating neck pain and cephalgia resulting from whiplash injuries (Lord S, et al: Percutaneous Radio-Frequency Neurotomy For Chronic Cervical Zygoapophyseal-Joint Pain, New Eng Jour Med 335:1771-1776, 1996). This double-blind placebo-controlled study using percutaneous RF facet blocks produced multiples sites of coagulation and demonstrated impressive lasting relief in the study group.  In a follow-up study ( McDonald GJ, Lord SM, Bogduk N: Long-term Follow-up of Patients Treated with Cervical Radiofrequency Neurotomy for Chronic Neck Pain) Neurosurg 45:61-68, 1999) long-term efficacy and repeatability were confirmed.

Schellhas200GIFIn the United States RF nerve blockade has been reported upon by Interventional Radiologist Kurt Schellhas, at the Center for Diagnostic Imaging in Minneapolis based on his long-term experience with diagnostic and therapeutic facet nerve procedures of the cervico- thoracic-lumbar spines.  Schellhas has been a leader in pointing out the need for well-defined techniques from the procedural standpoint and has documented the importance of using a high-resolution multidirectional C-arm imaging to assist in improving safety and efficacy.  With appropriate monitoring techniques these studies have become ideally suited for being performed in a ambulatory outpatient setting.

Some important clinical observations on the use of cervical radiofrequency facet (or medial branch) therapies is that multi-level screening temporary medial branch injections are often helpful in determining candidacy for the Radiofrequency blocks.  Multi-level procedures are the most effective as the sensory system is a diffuse one.  Caution is advised against patients submitting themselves to excessive and unwarranted series of injections and blocks being performed by procedurists whose primary interest is not the patient’s welfare.

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