Clinical Outcomes of Conventional Versus Lateral-Deployment RF Cannulas in Lumbar Medial Branch Radiofrequency Ablation: A Prospective Randomized Study.

OBJECTIVE

To compare conventional monopolar and lateral-deployment RF cannulas for lumbar medial branch radiofrequency ablation (RFA) in chronic facet-mediated low back pain.

DESIGN

Single-center, randomized, participant-blinded, two-arm superiority trial. Ninety participants were randomized 1:1; 84 with complete 6-month data were analyzed. The primary outcome was change in Numeric Rating Scale (NRS) pain intensity from baseline to 6 months. Secondary outcomes were changes in the Modified Oswestry Disability Index (MODI) and SF-12 Physical (PCS) and Mental (MCS) Component Scores.

RESULTS

Mean NRS change was -2.81 points with the conventional cannula and -5.52 points with the lateral-deployment cannula. The age-adjusted between-group difference was -2.795 points (95% CI, -3.967 to -1.624; P<0.001). At 6 months, at least 50% NRS reduction was achieved by 16/42 (38.1%) and 31/42 (73.8%) participants, respectively (risk ratio, 1.94; 95% CI, 1.27-2.97; P=0.001). Age-adjusted MODI and SF-12 PCS changes favored the lateral-deployment cannula. No major procedure-related complications were observed.

CONCLUSION

The lateral-deployment cannula was associated with greater 6-month improvements in pain, disability, and physical health and with more participants achieving substantial pain relief. Larger trials with intention-to-treat analyses are needed.