Management of non disco-genic low back pain: Our experience of 40 cases of RF rhizotomy

AimPatients with low back pain with no significant radicular pain and absent focal neurological deficit, who have received conservative treatment over a long period of time with no significant pain relief, need thorough assessment. Lumbar facet joint is an important pain generator in this group of patients and treatment using radiofrequency ablation is accessed, after patient selection by trial of facet joint block.SettingsA tertiary referral hospital in India (Indraprastha Apollo Hospital, New Delhi).Methods and material40 patients who had chronic low back pain with no radiculopathy. In addition nature of the pain along with aggravating and relieving factors and clinical examination in particular tender facets were identified. Trial of lumbar facet joint block was done for confirming source of pain. Subsequently radiofrequency rhizotomy of the median branch of dorsal nerve root supplying the painful facet was done as a definitive procedure.ResultsThe Modified Oswestry disability index showed significant improvement in all 40 patients immediate post procedure period. Recurrence of pain occurred within one month of rhizotomy in three patients; others remained pain free for longer durations.ConclusionsFacetal arthropathy is an important source of low back pain. Various treatment options are available for management of chronic low back pain. Lumbar facet joint block if leading to pain relief is diagnostic of facetal origin of back pain. Radiofrequency ablation of median branch of the dorsal nerve root is an effective and less invasive option for treatment of facet pain.