An Alternative Distal Approach for the Lumbar Medial Branch Radiofrequency Denervation: A Prospective Randomized Comparative Study
ABSTRACT BACKGROUND:An alternative technique involving a "distal approach" can be used for lumbar medial branch radiofrequency denervation (LMBRFD). We described and assessed this technique by comparing it with a conventional tunnel vision approach in a prospective randomized trial.METHODS:Eighty-two patients underwent LMBRFD by a distal (n = 41) or a tunnel vision approach (n = 41). The primary end point was a comparison of the mean difference in the change of 11-point numeric rating scale (NRS) scores of low back pain from entry to the scores at 1 month (NRS at baseline-NRS at 1 month) and at 6 months (NRS at baseline-NRS at 6 months) between the distal approach group and the tunnel vision approach group. The secondary end points were a change of NRS and the Oswestry disability index over time.RESULTS:Thirty-four patients in each group had complete time courses. There were no statistically significant differences in the change of NRS scores between the groups at 1 month (corrected P = 0.19; 97.5% 2-sided confidence interval [CI], -1.37 to 0.37) and 6 months (corrected P = 0.53; 97.5% CI, -1.36 to 0.77). Patients in both groups showed a statistically significant reduction in NRS and Oswestry disability index scores from baseline to that of the scores at 1 and 6 months (all P < 0.0001, Bonferroni corrected). The procedure-related pain score was significantly lower in the distal approach group (P = 0.001; 99% CI, -2.00 to -0.23).CONCLUSIONS:Patients who underwent LMBRFD by the tunnel vision or distal approaches showed significant pain relief at the 6-month follow-up. Less periprocedural pain was reported in the distal approach group. We consider that the distal approach provides an improved option for LMBRFD.
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ABSTRACT: Rhizolysis has been regarded as a controversial, but safe, procedure for the treatment of back pain. A case of a neuralgia-like pain syndrome resulting from transection of the lateral branches of the lumbar dorsal rami during rhizolysis is reported. The anatomy of the lumbar lateral branches is described, and their vulnerability is discussed. Attention is drawn to the likelihood of this complication with the use of rhizolysis in the vicinity of cutaneous branches of the dorsal ramiThe Medical journal of Australia 04/1981; 1(5):242-3. · 3.79 Impact Factor
Article: The human lumbar dorsal rami.[Show abstract] [Hide abstract]
ABSTRACT: The L 1-4 dorsal rami tend to form three branches, medial, lateral, and intermediate, which are distributed, respectively, to multifidus, iliocostalis, and longissimus. The intertransversarii mediales are innervated by a branch of the dorsal ramus near the origin of the medial branch. The L 4 dorsal ramus regularly forms three branches while the L 1-3 levels the lateral and intermediate branches may, alternatively, arise from a short common stem. The L 5 dorsal ramus is much longer than the others and forms only a medial and an intermediate branch. Each lumbar medial branch innervates two adjacent zygapophysial joints and ramifies in multifidus, supplying only those fascicles which arise from the spinous process with the same segmental number as the nerve. The comparative anatomy of the lumbar dorsal rami is discussed and the applied anatomy with respect to 'rhizolysis', 'facet denervation' and diagnostic paraspinal electromyography is described.Journal of Anatomy 04/1982; 134(Pt 2):383-97. · 2.23 Impact Factor
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ABSTRACT: Standard methods of using the t-test and the Wilcoxon test have deficiencies for comparing the means of two skewed log-normal samples. In this paper, we propose two new methods to overcome these deficiencies: (1) a likelihood-based approach and (2) a bootstrap-based approach. Our simulation study shows that the likelihood-based approach is the best in terms of the type I error rate and power when data follow a log-normal distribution.Biometrics 10/1997; 53(3):1129-35. DOI:10.2307/2533570 · 1.52 Impact Factor