Table 21.
Studies examining the effectiveness of repeat cervical medial branch RFA
| Author, year | Patients | Joints included | Design | Successful outcome | Results: Success | Duration of benefit |
|---|---|---|---|---|---|---|
| Lord et al 1996 [68] | 24 pts diagnosed with cervical facet pain based on three blocks including one with saline | C3–C7 | Randomized, placebo-controlled | Complete pain relief for ≥90 days. Duration of benefit was time for pain to return to ≥50% of baseline |
Active group initial RFA failure: 2 of 5 (40%) had successful procedure Control group: 4 of 5 (80%) had success |
Median duration for initial RFA 263 days vs 253 days for repeat RFA |
| Lord et al 1995 [312] | 19 pts with chronic cervical facet pain after MVC diagnosed by dual blocks | C2–C7 | Retrospective | Complete relief for a clinically significant duration | C2–3: Initial RFA success rate: 4 of 10 (40%) Repeat RFA success rate: 2 of 2 (100%) C5–C7: Initial RFA success rate: 7 of 10 (70%) Repeat RFA success rate: 3 of 3 (100%) |
|
| Lord et al 1998 [202] | 12 pts with cervical facet pain from C2–3 after MVC diagnosed by dual comparative or placebo-controlled blocks | C2–3 | Retrospective | Complete relief in the region treated for ≥90 days. Duration of benefit was time for pain to return to ≥50% of baseline | Initial RFA success (pts): 5 of 12 (42%) Repeat RFA success rate (procedures): 10 of 13 (77%) |
Median duration of initial successful RFA 161 days vs 237 days for repeat RFA |
| McDonald et al 1999 [149] | 28 pts with cervical facet pain from C2–3 after MVC diagnosed by dual comparative or placebo-controlled blocks | C3–C7 | Retrospective | Complete relief for a clinically significant duration | Initial RFA success rate: 18 of 28 (64%) Repeat RFA success rate: 7 of 8 (87.5%) Initial RFA failure: 10 of 28 (36%) Repeat RFA success rate after initial RFA failure: 2 of 6 (33%) |
Median duration of initial successful RFA 421 days vs 181.5 days for first repeat RFA. Median duration of all successful repeat RFAs: 218.5 days |
| Govind et al 2003 [307] | 49 pts with complete pain relief with dual comparative blocks (2 pts with bilateral pain) | TON/C2–3 | Retrospective | Complete relief of headache and restoration of function for 90 days | Initial RFA success rate: 43 of 49 (88%). Repeat RFA success rate: 12 of 14 (86%) |
Mean duration of relief after initial successful RFA: 297 days. Mean duration of relief after repeat RFA: 217 days |
| Barnsley, 2005 [101] | 35 pts with complete relief of pain with dual comparative blocks and no relief with placebo injection. 12 pts received repeat RFA |
C2–C7 | Retrospective | Complete relief of neck pain | Initial RFA success rate: 26 of 35 (74%) Repeat RFA success rate: 8 of 9 (89%) Initial RFA failure rate: 7 of 33 (21%) Repeat RFA success rate after failure: 2 of 3 (67%) |
Median duration of relief after initial successful RFA: 36 weeks Duration of relief after repeat successful RFA: not reported |
| Husted et al 2008 [389] | 22 pts with ‘good’ relief from 2 MBBs and ≥50% relief after RFA | C2–C7 | Retrospective | ≥50% pain relief | Initial RFA success rate: 22 of 22 (100%) Repeat RFA success (procedures): 39 of 41 (95%) 21 pts had a second RFA 11, 4, 2, 2, 1 patients had a third, fourth, fifth, sixth, and seventh repeat procedure |
Mean duration of initial successful RFA: 12.5 months. Mean duration for subsequent successful RFAs: 11.5 months |
| Rambaransingh et al 2010 [393] | 73 pts with cervical and lumbar pain who received >3-point pain reduction (on 0–11 scale) with RFA. 15/73 pts underwent repeat cervical RFA |
Levels unreported | Observational | Improvement in pain and disability | Pain reduction and functional improvement remained significantly improved from baseline with each repeat procedure. 43% success rate (≥50% improvement) vs 64% with second RFA and 86% with third RFA |
Mean duration of relief after initial successful RFA: 9.9 months. Mean duration of relief after second successful RFA: 10.5 months (not reported for third RFA) |
| Speldewinde, 2011 [392] | 151 pts with ≥80% relief from dual comparative MBB blocks. 26 pts underwent repeat RFA, 47 procedures |
Levels unreported | Observational | ≥50% pain reduction for ≥2 months | Initial RFA success: 112 of 151 (76%) Repeat RFA success rate after initial successful RFA (procedures) 34 of 40 (85%) Repeat RFA success rate after initial failure: 4 of 7 (57%) |
Mean duration of success after initial RFA 12 months vs 9.7 after repeat RFA |
| MacVicar et al 2012 [69] | 104 pts with complete relief of pain from dual comparative blocks | C2–7 | Observational | Successful outcome: ≥80% pain relief for at least 6 months with complete restoration of ADLs | Initial RFA success rate: 69 of 104 (66%) Repeat RFA success rate after initial success: 23 of 24 (96%) Repeat RFA success rate after initial failure: 2 of 2 (100%) |
Median duration of pain relief after initial RFA 17 months and 20 months in two practices. Median duration of pain relief after repeat RFA 15 months |
ADLs, activities of daily living; MVC, motor vehicle collision; pts, patients; RFA, radiofrequency ablation.