Re: radiofrequency for lumbar facet sclerosis?
I have not had this procedure done, although it is being considered as a future strategy for my facet joint arthritis which has caused foraminal stenosis and l5/s1 radiculopathy. I went on Google and did a search of "percutaneous radiofrequency" and found a bunch of stuff which implies that the procedure can be wonderfully helpful IF you are the right candidate.
I also found the following, which I thought interesting because it shows the procedure from the point of view of an insurance company (BC/BS of Georgia).
Medical Policy 3.07.05
PERCUTANEOUS RADIO-FREQUENCY NEUROLYTIC DESTRUCTION OF FACET JOINT NERVES
Chronic low back pain is frequently attributed to disorders of the facet joint. Neck pain related to whiplash injury is also thought to be related to the cervical zygapophyseal facet joint. However, the diagnosis of facet joint pain is difficult and often is based on pain relief following a diagnostic pain block of the medial branch of the posterior rami of the spinal nerve supplying the facet joint.
Radiofrequency neurolytic destruction of the medial branch of the posterior rami of the spinal nerve has been investigated as a technique to denervate the facet joint. Other therapies include injections with local anesthetics, steroids or phenol in and around the facet joint. While these techniques can produce short term pain relief, it is hoped that the use of radiofrequency ablation will produce more durable pain relief.
Percutaneous radio-frequency neurotomy may be MEDICALLY NECESSARY for patients who meet the following criteria:
the cervical zygapophyseal or lumbar joint pain has been confirmed with the use of local anesthetic blocks; and the condition is chronic and has not responded to conservative treatment.
Randomized trials of radiofrequency ablation to denervate the cervicozygapophyseal joint and lumbar joints suggest that the technique is an effective means of producing pain relief. In these studies radiofrequency ablation was limited to those patients who reported pain relief with a diagnostic nerve block. In addition, the technique was most successful in patients without a prior history of back surgery.
Lord SM, Barnsley L, Wallis BJ et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335:1721-6.
Van Kleef M, Barendse GA, Kessels A et al. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999;24:1937-42.
Gallagher J, et al. Radiofrequency facet joint denervation in the treatment of low back pain: A prospective controlled double-blind study to assess its efficacy. Clin J Pain 1994;7:193-198.