Radiofrequency ablation for patients with lumbar spinal arthritis provides quantifiable improvement in gait velocity: a prospective study

• Published in: Regional anesthesia and pain medicine p. rapm-2023-105244
• Main Authors: Goree, Johnathan Heck, Tobey-Moore, Leah R, Petersen, Erika, White, Cale, Judkins, Daniel, Brown, George Austin, Virmani, Tuhin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 22.02.2024; BMJ Publishing Group LTD
• Subjects: Ablation; Anesthesiology; Arthritis; Back Pain; Body mass index; CHRONIC PAIN; Consent; Diagnostic Techniques and Procedures; Funding; Gait; Injections, Spinal; Medical diagnosis; Parkinson's disease; Patients; Questionnaires; Research report; Review boards; Velocity; Walking; Walkways; Injections, Spinal; Back Pain; Diagnostic Techniques and Procedures; CHRONIC PAIN
• ISSN: 1098-7339; 1532-8651; 1532-8651
• DOI: 10.1136/rapm-2023-105244

Correspondence to Dr Johnathan Heck Goree, Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7101, USA; jhgoree@uams.edu Introduction Technically precise radiofrequency ablation (RFA) of the medial branch nerves, a minimally invasive percutaneous procedure of lumbar facets in patients experiencing lumbar facet-mediated pain, is a well-evidenced and effective treatment for painful lumbar spinal arthritis.1 Since studies have reported gait alterations, particularly slower speeds, in patients with chronic low back pain (LBP),2 the primary aim of this study is to characterize quantifiable gait velocity parameters via the Zeno Walkway (commonly used for gait analysis in neurodegenerative diseases like Parkinson’s),3 following RFA. Inclusion criteria included >18 years old with chronic, non-radicular LBP lasting longer than 6 months, rated >5/10 pain severity per Visual Analog Scale; failed conservative management with physical therapy (PT) and oral medications, most commonly non-steroidal anti-inflammatories (NSAIDs); and clinical diagnosis of lumbar facet-mediated LBP by a board-certified, pain fellowship-trained anesthesiologist concluded through physical examination, X-ray images, and two sets of prognostic lumbar medial branch block (MBBs)5 (0.5 cc of 0.5% bupivacaine) between L2 and L5 (level chosen based on imaging and exam), demonstrating >80% improvement within 24 hours post-block. Results Analysis using paired t-test of a subject’s ambulation velocity demonstrated a significant difference (p=0.038; reported as 0.04 in table 2) with an improvement of 79.9 cm/s (1.78mph) pre-RFA to 87.3 cm/s (1.95mph) post-RFA; paired t-tests also showed statistically significant reductions in subjective pain measured per PDI and ODI. Ethics approval This study involves human participants and was approved by the University of Arkansas for Medical Sciences Institutional Review Board (IRB#204621).