Radiofrequency denervation of the lumbar zygapophysial joints - Targeting the best practice

Objective. Radiofrequency denervation of the zygapophysial (facet) joint is a frequently performed procedure for chronic low back pain. Several studies have shown considerable efficacy of the procedure, but none of the randomized controlled trials performed to date has used anatomically correct placement of radiofrequency cannula parallel to the target nerve. Three main techniques have been utilized for many years: North American, European, and Australian. Each has conceptual and technical limitations. This review analyzes these techniques and proposes a standardized technique of radiofrequency denervation of lumbar zygapophysial joints. Design. Current techniques of radiofrequency neurotomy were analyzed with respect to anatomic and technical accuracy. Step by step guidelines were developed using a combination of previously described techniques along with newly elaborated technical hints and details. Conclusion. We believe that the technique using "tunnel vision" with anatomically appropriate cannula placement and use of a large-bore, curved needle with a 10-mm active tip may improve the results of radiofrequency denervation of lumbar zygapophysial joints. Providing a detailed description of an anatomically accurate technique should be of value to those seeking to perform this procedure in a valid manner.