Abstract
The thoracic facet joint has been shown to be a source of spinal pain with reported prevalence of 34-48% . There is limited published literature on the RF neurotomy of the thoracic medial branches, where no meaningful conclusion can be derived. This is largely due to incorrect targets being ablated and the retrospective nature of these studies. The limited options for the treatment of thoracic spinal pain and the risk of puncturing the pleura cavity in the complex regional anatomy may be some of the reasons for the lack of published literature.
We present a novel electrode placement technique to target the thoracic medial branches described by Chua and Bogduk . The technique directs the introducer needle towards the ‘thoracic safe zone’ to target the superolateral aspect of the transverse process which is a bony landmark that is easily identifiable under fluoroscopy. Combining the placement technique with cooled radiofrequency neurotomy, a consistent zone of ablation that is sufficiently large to capture the thoracic medial branches can be created.
Evaluation of the safety and efficacy of thoracic facet joint denervation using this novel technique for cooled radiofrequency neurotomy is performed in a prospective case series of 13 patients. Over a 12-month follow-up period, the mean VAS score was reduced by more than 3 points at each of the follow-up time points. Over 67% of patients experienced more than 50% pain relief 1 and 3 months after treatment that persisted in 58% of patients at 6 months post-treatment. At the 9-12 month visit, 3 patients were lost to follow up. Of the remaining 10 patients, 60% of patients continued to experience more than 50% pain relief. In ODI, 58% and 42% of patients experienced a reduction of 10 points or more at 3 and 6 months post-treatment, respectively. Of the remaining 10 patients at 9-12 months follow up, 30% of patients experienced 10-point drop in ODI. Significant improvement in SF-36 bodily pain and physical functioning scores compared to baseline were also observed in the patients at 3-months, with 82% and 73% of patients experiencing ≥ 10-point improvement, respectively. There were no complications reported during and after the treatment over the 12-month follow-up period. Overall, the novel needle placement technique combined with cooled radiofrequency may be a safe and effective treatment option for thoracic facet joint denervation with significant clinical promise.
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