Lumbar Facet Arthropathy Guidelines

Updated: Feb 02, 2022
  • Author: Carl H Shin, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Guidelines

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