1000 Section - Does increasing thermal lesion temperature improve cervical and lumbar facet joint radiofrequency neurotomy outcomes? A matched prospective cohort study

Radiofrequency neurotomy (RFN) is a minimally invasive, evidence-based procedure for managing refractory facet-mediated spine pain. Although effective, pain relief is often partial and temporary. Recent research suggests that increasing lumbar RFN lesion temperature from 80°C to 90°C may enhance both the magnitude and duration of relief.[1] However, comparable evidence for cervical and lumbar RFN is limited. This study evaluated whether raising lesion temperature to 90°C improves outcomes for both cervical and lumbar RFN.

Design: In this single-arm prospective cohort study, 376 first-time RFNs (89 cervical, 287 lumbar) were performed at 90°C at two Canadian musculoskeletal pain clinics. Each was matched to a historical 80°C RFN control based on selection block paradigm, cannula type, and spinal level treated. Pain and function were assessed using the Numerical Rating Scale (NRS) and Pain Disability and Quality of Life Questionnaire (PDQQ) at baseline and 3 months post-procedure. Incidence of post-RFN neuritis was also recorded. Chi-square analysis was used for comparison of proportions.

Results: The proportion of patients achieving minimal clinically important difference (MCID) for NRS was 71% (80°C) vs. 67% (90°C) (χ² = 1.2; p = 0.27). For PDQQ, MCID was achieved in 49% (80°C) vs. 51% (90°C) (χ² = 0.2; p = 0.63). Neuritis occurred significantly more often in the 90°C group (19.1%) than the 80°C group (2.4%) (χ² = 54.6; p < 0.0001), with cervical RFNs showing 3.6 times higher neuritis rates than lumbar RFNs.

Conclusion: Raising RFN lesion temperature to 90°C did not add additional short-term pain or functional improvements for cervical or lumbar RFN. However, it was associated with a significantly increased risk of post-procedural neuritis, particularly in the cervical spine.