Guidelines Summary

American Society of Pain and Neuroscience

Best practice guidelines from the American Society of Pain and Neuroscience on RF neurotomy included the following for the lumbar spine^[65]:

Lumbar RF neurotomy (LRFN) is primarily employed for symptoms of low back pain with no radicular symptoms
MRI or CT scanning should be used prior to LRFN, to rule out other possible etiologies; imaging, however, is not effective in diagnosing facet-mediated pain, and the use of LRFN is not necessarily excluded by the presence of discogenic changes
In terms of success with LRFN, intra-articular facet injections are generally considered to be less predictive than medial branch blocks
In instances of recurrent pain, repeat LRFN’s efficacy has been found to be highly reproducible
Although additional evidence is needed, electrodes are optimally positioned parallel to the target nerves
Prior to LRFN, in order to make sure that the electrode tip has been appropriately placed and to avoid unintentional lesioning of the ventral ramus or other structures, motor and sensory testing is recommended
The supporting evidence is strongest for the use of conventional thermal RF (60-80°C) for 60-90 seconds

Medication

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[Guideline] Lee DW, Pritzlaff S, Jung MJ, et al. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res. 2021. 14:2807-31. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Anteroposterior view of right L4-5 facet intra-articular injection with contrast.
Lateral view of right L4-5 facet intra-articular injection with contrast.
Oblique view of right L4-5 facet intra-articular injection with contrast.
Anteroposterior view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala).
Lateral view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala, just below the L5-S1 facet joint).
Anteroposterior view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process).
Lateral view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process, just below L4-5 facet joint).

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Author

Carl H Shin, MD Consulting Staff, Department of Physical Medicine and Rehabilitation, University of Pennsylvania

Carl H Shin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Curtis W Slipman, MD Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, North American Spine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

J Michael Wieting, DO, MEd, FAOCPMR, FAAOE Senior Associate Dean, Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Manipulative Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

J Michael Wieting, DO, MEd, FAOCPMR, FAAOE is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Osteopathic Examiners, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Gold Humanism Honor Society, International Society for Communication Science and Medicine, Michigan Osteopathic Association, Oklahoma Osteopathic Association, Tennessee Osteopathic Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The editors wish to gratefully acknowledge Mark I Ellen, MD, Assistant Professor, Department of Orthopedics and Rehabilitation Medicine, The Emory Sports Medicine Center, for his previous participation in this article.

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