PM&R
Volume 1, Issue 8 , Pages 719-722, August 2009

The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain

  • Paul Dreyfuss, MD

      Affiliations

    • Clinical Professor, Department of Rehabilitation Medicine, University of Washington, 21108 NE 129th CT, Woodinville, WA 98077†
    • Corresponding Author InformationAddress correspondence to: P.D.
    • ,
  • Alison Stout, DO

      Affiliations

    • Acting Assistant Professor, Veterans Affairs Health Care Services, Department of Rehabilitation Medicine, University of Washington, Seattle, WA‡
    • ,
  • Charles Aprill, MD

      Affiliations

    • Magnolia Diagnostics, New Orleans, LA§
    • ,
  • Steve Pollei, MD

      Affiliations

    • Center for Diagnostic Imaging, Tacoma, WA
    • ,
  • Blake Johnson, MD

      Affiliations

    • Center for Diagnostic Imaging, St. Louis Park, MN∥
    • ,
  • Nikolai Bogduk, MD, PhD

      Affiliations

    • University of Newcastle, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, New South Wales, Australia#

Received 17 November 2008; accepted 26 May 2009.

Objective

To determine the presence of lumbar multifidus atrophy and pain after successful lumbar medial branch radiofrequency neurotomy for zygapophysial joint mediated pain.

Design

A prospective observational analysis of 5 patients who had undergone successful unilateral radiofrequency neurotomy (RFN) of the lumbar medial branch divisions of the lumbar dorsal rami. At 17 to 26 months after RFN, 3 blinded radiologists evaluated the relative composition and size of the multifidus muscle at different segmental levels on lumbar magnetic resonance imaging (MRI). They were asked to determine the lesioned levels by evidence of multifidus atrophy. The accuracy of predicting the correct side and level lesioned was evaluated.

Setting

Private spine practice in Tyler, Texas.

Patients

Five patients who had unilateral lumbar medial branch RFN for proven lumbar zygapophysial joint-mediated pain were selected.

Interventions

MRI of the lumbar spine at a mean of 21 months (range, 17-26) after successful lumbar RFN.

Outcome Measures

Multifidus atrophy on a lumbar MRI, pain assessment and use of cointerventions.

Results

Diffuse lumbar multifidus atrophy was detectable with MRI. However, radiologists could not reliably predict the side and segments lesioned. Despite denervation of the multifidus, at 12 months after RFN all subjects had ongoing pain relief and did not require or request additional treatment.

Conclusions

This preliminary study provides evidence that successful medial branch RFN for lumbar zygapophysial-mediated pain does cause initial denervation but no discernable segmental atrophy of the multifidus at long-term follow-up. Previous denervation and diffuse atrophy in these subjects was not associated with pain.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: 2A, Daniel Sachs, venture capitalist
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose
  • # Disclosure: nothing to disclose

 This CME activity is designated for 1.0 AMA PRA Category 1 Credit™ and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. At $10 per activity for AAPM&R members, journal CME is a cost-effective option for obtaining Category 1 CME credit!

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This study was funded by a grant from the International Spinal Intervention Society (ISIS). This study was also possible through the generosity of the ETMC Neurological Institute and HealthSouth Imaging in Tyler, Texas.

PII: S1934-1482(09)00546-2

doi:10.1016/j.pmrj.2009.05.014

PM&R
Volume 1, Issue 8 , Pages 719-722, August 2009

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