427: The Efficacy of Repeat Medial Branch Radiofrequency Ablation

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Treatment/management

Background and Aims: Facet joints, or zygapophyseal joints, are a common source of persistent spinal pain in 15 to 45% of chronic low back pain patients, 36 to 60% of chronic neck pain patients, and 34 to 48% of thoracic pain patients [1]. Facet joints are innervated by the medial branches of the dorsal rami. Radiofrequency ablation (RFA) of these medial branches is one option for management of facet mediated pain. This study aims to characterize the efficacy of repeated medial branch RFA procedures along with the maximum number of RFA procedures performed at the cervical, thoracic, and lumbar levels.

Methods: A single institution, retrospective chart review was conducted of patients undergoing repeated medial branch radiofrequency nerve ablation for cervical, thoracic, or lumbar facet arthropathy at the same levels from January of 2004 to March of 2026. A total of 33 cervical, 7 thoracic, and 55 lumbar medial branch RFA patients were identified. Data was then analyzed to establish if there was a significant relationship between number of RFAs, the time between RFAs, whether the procedure was unilateral or bilateral, or the reported VAS pain scale prior to the procedure and the percent of pain relief and duration of pain relief. The success rate at each successive RFA was also characterized.

Results: It was found that at both cervical (p = 0.1323) and lumbar (p = 0.3495) levels the RFA count does not have a statistically significant effect on either the percent pain relief reported or the reported pain relief duration. At lumbar levels the only variable studied that was found to have a statistically significant effect was the duration of time between subsequent RFAs, with longer time between RFAs resulting in shorter duration of pain relief (p < 0.05) and less total pain relief (p < 0.05). At cervical levels the maximum number of RFA procedures characterized was 8, at lumbar levels the maximum number of RFA procedures characterized was 9, and at thoracic levels the maximum number of RFA procedures characterized was 4.

Conclusions: Repeat medial branch radiofrequency ablations remain successful at high rates in individuals with prior successful medial branch RFA procedures at the same levels.

References: 1. Boswell, M. V., Colson, J. D., Sehgal, N., Dunbar, E. E., & Epter, R. (2007). A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician, 10(1), 229–253. https://doi.org/10.36076/ppj.2007/10/229

Presenting Author: Samantha Kultgen, MD
Submitting Author: Samantha Kultgen

Senior Author: Nalini Sehgal, MD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Samantha Kultgen: MD - University of Wisconsin-Madison/University of Alabama-Birmingham
• Nalini Sehgal: MD - University of Wisconsin-Madison