The effectiveness of cervical medial branch radiofrequency neurotomy using a perpendicular approach with a three-tined probe: A single-arm, retrospective cohort study

David Civitarese; Andrew Stephens; Timothy M Curtis; Chase Young; Alexa G Ries; Amanda N Cooper; Brook Martin; Alycia Amatto; Robert S Burnham; Aaron M Conger; Zachary L McCormick; Taylor R Burnham

doi:10.1016/j.inpm.2025.100572

The effectiveness of cervical medial branch radiofrequency neurotomy using a perpendicular approach with a three-tined probe: A single-arm, retrospective cohort study

Interv Pain Med. 2025 Mar 19;4(1):100572. doi: 10.1016/j.inpm.2025.100572. eCollection 2025 Mar.

Authors

David Civitarese¹, Andrew Stephens², Timothy M Curtis³, Chase Young³, Alexa G Ries⁴, Amanda N Cooper³, Brook Martin⁵, Alycia Amatto⁶, Robert S Burnham^{6

7

8}, Aaron M Conger³, Zachary L McCormick³, Taylor R Burnham^{3

8

9}

Affiliations

¹ Shirley Ryan AbilityLab, Chicago, IL, USA.
² Department of Physical Medicine and Rehabilitation, University of Rochester, Rochester, NY, USA.
³ Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
⁴ University of Utah School of Medicine, Salt Lake City, UT, USA.
⁵ Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA.
⁶ Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁷ Central Alberta Pain and Rehabilitation Institute, Lacombe, Alberta, Canada.
⁸ Vivo Cura Health, Calgary, Alberta, Canada.
⁹ Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.

Abstract

Background: Cervical medial branch radiofrequency neurotomy (CMBRFN) with a parallel approach has been proven to be an effective treatment for zygapophyseal joint-mediated cervical pain. Technological advancements in radiofrequency probe design have allowed for a perpendicular approach to electrode placement. However, the effectiveness of the perpendicular approach remains to be fully understood.

Objectives: Evaluate the effectiveness of CMBRFN with a perpendicular approach (pCMBRFN) in patients with confirmed zygapophyseal joint-mediated cervical pain.

Methods: This single-arm, retrospective cohort study included patients identified between 2016 and 2022 who underwent pCMBRFN after demonstrating ≥80 % pain relief with two consecutive diagnostic medial branch blocks (MBB). Primary outcomes were ≥50 % patient-reported numeric rating scale (NRS) pain relief and minimal clinically important difference (MCID) on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3 months post-procedure. Secondary outcomes were mean patient-reported retrospective percentage pain relief and duration of relief after a successful pCMBRFN in individuals who presented for repeat pCMBRFN upon return of their symptoms.

Results: A total of 52 participants (63.5 % female; mean age 55.9 ± 10.9 years; mean BMI 26.8 ± 5.2 kg/m²) were analyzed. At 3 months post-procedure, ≥50 % NRS pain reduction and MCID on PDQQ-S were both reported by 34 patients (65.4 % [95%CI 51.8-76.9]). Of the 34 patients with successful treatment response, 15 had return of symptoms after an average of 8.8 ± 2.5 months with a reported mean percentage pain relief of 86.0 ± 14.9 %.

Conclusion: Within this cohort, pCMBRFN demonstrated effectiveness by reducing pain and disability in over 65 % of patients with confirmed cervical zygapophyseal joint-mediated pain at 3 months. Patients with successful treatment outcomes whose index symptoms eventually returned reported an average pain reduction of 86 % lasting approximately 9 months. Larger prospective studies with long-term follow-up are needed to confirm these results.

Keywords: Cervical facet pain; Medial branch nerve; Radiofrequency ablation.