Description of Treatment:
Back pain is a common complaint. In many patients, the pain will either resolve spontaneously or respond to conservative therapy, however, the pain becomes chronic for some patients. Percutaneous radiofrequency ablation has been proposed as a minimally invasive treatment for chronic neck and back pain. This report focuses on ablation of the medial branch of the dorsal rami (i.e., medial branch neurotomy) for facet-mediated cervical or lumbar pain that has failed to respond to conservative therapy including therapeutic exercise, activity modification, medical therapy, joint injections, and nerve blocks. Facet joint pain may be due to degeneration, inflammation, or injury. It is estimated that 15% to 45% of low back pain and 54% to 60% of neck pain is related to facet joints. To achieve success, it is imperative that the procedure be performed for the correct diagnosis. The diagnosis of facet-mediated pain is typically established by the use of comparative diagnostic nerve blocks to reduce the likelihood of false-positive findings. It is also critical that the procedure be done under fluoroscopic guidance. Few complications have been reported but neural regrowth may result in a return of symptoms. It is unknown how many times the procedure may be repeated.

Committee Conclusions
With regard to percutaneous radiofrequency ablation, the ICSI Technology Assessment Committee finds:

1. Percutaneous radiofrequency ablation is a safe procedure for patients who are correctly diagnosed with facet joint pain.
2. To date, there is only one randomized, controlled trial that has assessed patient outcomes associated with percutaneous radiofrequency ablation for cervical facet joint pain. In that trial, percutaneous radiofrequency ablation was associated with a greater level of pain relief at 3 months post-treatment and patients were less likely to return to pre-treatment pain levels or, at least, the return was delayed following active treatment. Therefore, percutaneous radiofrequency ablation may be an alternative for the patient who has failed an adequate trial of conservative therapy (including therapeutic exercise, activity modification, medical therapy, joint injections, and nerve blocks). (Conclusion Grade III)
3. The scientific evidence, to date, does not permit a conclusion to be reached regarding the efficacy of percutaneous radiofrequency ablation for lumbar facet joint pain. (Conclusion Grade Not Assignable)