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Multifidus atrophy and/or dysfunction following lumbar radiofrequency ablation: A systematic review.
Tieppo Francio, Vinicius; Glicksman, Michael; Leavitt, Logan; Gill, Benjamin; Shah, Anuj; Westerhaus, Benjamin D; Lam, Christopher M; D'Souza, Ryan S.
Affiliation
  • Tieppo Francio V; Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA.
  • Glicksman M; Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA.
  • Leavitt L; Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Gill B; Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA.
  • Shah A; Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA.
  • Westerhaus BD; Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, Michigan, USA.
  • Lam CM; Cantor Spine Center at the Paley Orthopedic & Spine Institute, West Palm Beach, Florida, USA.
  • D'Souza RS; Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA.
PM R ; 2024 May 16.
Article in En | MEDLINE | ID: mdl-38757474
ABSTRACT

BACKGROUND:

Lumbar medial branch nerve radiofrequency ablation (LRFA) is an interventional procedure used to treat chronic lumbar facet joint pain. Because the medial branch nerves also innervate the multifidus muscle, it has been proposed that LRFA may pose a risk of multifidus atrophy and/or dysfunction. However, the quality and level of evidence to answer this clinical question have not been established. Therefore, this review aimed to systematically appraise the literature to discern whether the prevailing evidence substantiates the hypothesis in question.

METHODS:

A systematic review compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to evaluate the quality and level of evidence of studies reporting functional and/or structural changes in the multifidus muscle following LRFA.

RESULTS:

Only five cohort studies met inclusion criteria. Two studies assessed changes in multifidus function following LRFA with confirmed denervation at electromyography and significant reduction in multifidus shear modulus with ultrasound shear wave elastography. Of the four studies that evaluated changes in multifidus structure with magnetic resonance imaging following LRFA, two demonstrated a decrease in cross-sectional area or an increase in fat infiltration, one demonstrated no change, and one revealed an apparent increase. Given the destructive nature attributed to LRFA, some degree of multifidus atrophy and/or dysfunction may be plausible, albeit with a very low certainty that relies on a restricted body of literature of modest quality and with a presence of high bias.

CONCLUSION:

There is a paucity of studies discussing the potential association between LRFA and multifidus atrophy and/or dysfunction. In light of the shortage of high-quality studies and the absence of standardized protocols to assess both changes in the structure and function of the multifidus subsequent to LRFA, there is a pressing need for more prospective studies with a high methodological rigor to comprehensively address and answer this enduring debate in clinical practice.

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: PM R Journal subject: MEDICINA FISICA / REABILITACAO / TRAUMATOLOGIA Year: 2024 Document type: Article Affiliation country: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: PM R Journal subject: MEDICINA FISICA / REABILITACAO / TRAUMATOLOGIA Year: 2024 Document type: Article Affiliation country: United States