Percutaneous Endoscopic Cervical Medial Branch Neurotomy For Chronic Cervical Zygapophyseal Joint Pain: A Pilot Study

Percutaneous radiofrequency neurotomy (PRN) is a neurosurgical technique for chronic cervical zygapophyseal joint (Z-joint) pain. However, its failure of some 30% of patients to respond may be compatible with inadequate patient selection, anatomic variation of MB, malposition of electrode, incomplete ablation, and regeneration of MB, etc. In theory, pain will return when the axons regenerate and nociceptive transduction is reinstated. This study aims to evaluate the effect and safety of a newly established percutaneous endoscopic cervical medial branch neurotomy (PECMBN) technique for chronic cervical Z-joint pain. 25 patients of cervical Z-joints pain diagnosed by means of placebo-controlled, diagnostic triple anesthetic medial branch blocks (MBB) were non-randomly divided into conservative group (11 cases) receiving conservative treatment and operation group (14 cases) receiving PECMBN in which target MBs were exposed endoscopically and cut off with micro-punch and ablated with tip-flexible radiofrequency electrode. Visual analogue score (VAS) of neck pain and referred pain were followed up. The MacNab score was recorded at 12 months postoperatively. Results show that the percentage of pain relief (neck/referred) at any time point postoperatively in operation group was higher compared to that in conservative group. MacNab outcomes in operation group were significantly better than that in conservative group. So we concluded that PECMBN for chronic cervical Z-joint pain is an accurate, effective and safe minimally invasive spine surgery. Higher success rate can be achieved compared with reported outcomes of PRN without complications increased.