Lumbar Dorsal Ramus Syndrome: Management with Radiofrequency Facet Rhizotomy.

Nam, Taek Gyun; Park, Seung Won

Original Article

Journal of Korean Neurosurgical Society 2003;34(4): 319-324.

Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea. nspsw@cau.ac.kr

ABSTRACT

OBJECTIVE
So called "lumbar dorsal ramus syndrome(LDRS)" is known to have low back pain(LBP) with buttock and/or leg pain, and considered one of the causes of chronic LBP. The radiofrequency facet rhizotomy (RFFR) is known to be effective treatment for the selected patients with chronic LBP. The goal of this study is to evaluate the therapeutic effectiveness of RFFR in patients with LDRS. METHODS: LDRS is mainly diagnosed by way of blocking the lumbar dorsal ramus with local anesthetics. Their accompanied spinal conditions are sprain, stenosis, HNP, and fracture. These patients underwent unilateral or bilateral RFFR at L4, L5, and S1 levels, from August, 1999 to May, 2000. Results were graded at the end of follow up as excellent, good, fair, and poor. Successful result was considered when excellent or good grades were obtained. RESULTS: Total number of patients received RFFR was 75. The number of LDRS with sprain was 46(8.5% of patients with sprain). Mean age and male to female ratio were 51.8+/-16.7 and 1:1.4, respectively. Mean follow up period was 340.0+/-232.2 days(1month - 2years). Characteristic tender points were posterior superior iliac crest, anterolateral aspect of inferior thigh, posterior aspect of femoral head, and medial side of heel. The success rate at the last follow-up in total patients and patients with sprain were 73.3% and 87.0%, respectively. Other combined spinal conditions except sprain seemed to have undesirable influence on the result of RFFR(p<0.05).
CONCLUSION
RFFR is fairly effective treatment for LDRS, especially for the patient with sprain. Combined spinal conditions other than sprain are poor prognostic factors.

Key Words: Lumbar; Dorsal ramus; Radiofrequency; Facet; Rhizotomy