Radiofrequency Neurotomy for Treatment of Low Back Pain in Patients with Minor Degenerative Spondylolisthesis

Background: Degenerative spondylolisthesis is one of the major causes for low back pain.Morphological abnormalities of the zygapophysial joints are a predisposing factor in the developmentof degenerative spondylolisthesis. Therefore, radiofrequency neurotomy seems to be a rationaltherapy.Objectives: To determine if radiofrequency neurotomy is effective for patients with low back painand degenerative spondylolisthesis.Study design: Retrospective practice audit.Setting: Single spine centerMethods: Charts of all patients with degenerative spondylolisthesis who underwent treatmentwith radiofrequency neurotomy during a time period of 3 years were reviewed. Only patients withmagnetic resonance imaging confirming the diagnosis were included. Patients with a lumbar spineoperation in their history, patients with neurological deficits, and patients with a follow-up less than3 months were excluded. Patients were treated with lumbar radiofrequency neurotomy. Positivetreatment response was defined as at least a 50% reduction in pain. A radiofrequency neurotomywas only performed after positive diagnostic medial branch blocks.Results: During a time period of 3 years, 1,490 patients were treated with lumbar radiofrequencyneurotomy. Forty of these patients with degenerative spondylolisthesis were included. A significantpain reduction was achieved in 65 % of the patients.Limitations: This audit is retrospective and observational, and therefore does not represent ahigh level of evidence. However, to our knowledge, since this information has not been previouslyreported and no specific nonoperative treatment for lumbar pain in patients with degenerativespondylolisthesis exists, it appears to be the best available research upon which to recommendtreatment and to plan higher quality studies.Conclusions: Zygapophysial joints are a possible source of pain in patients with spondylolisthesis.Radiofrequency neurotomy is a rational, specific nonoperative therapy in addition to othernonoperative therapy methods with a success rate of 65%. This is the first study to determine theeffect of radiofrequency neurotomy in patients with minor degenerative spondylolisthesis.Key words: degenerative spondylolisthesis, zygapophysial joints, facet joints, radiofrequencyneurotomy, medial branch, pain therapy, back pain