Sota Omoigui, MD — L.A. Pain Clinic

Screens and anaylzes medical records for standard of care, causation and damages.

Ineffective and unnecessary procedures range from transforaminal injections, radiofrequency thermal lesioning of the medial branch nerves, radiofrequency cryolesioning of the medial branch nerves, intradiscal electrothermy (thermal burn to the intervertebral disc), and spinal cord stimulation. Recent randomized control trials have also questioned the effectiveness of these more invasive procedures. A multicenter, randomized, double-blind, sham treatment controlled trial was performed to determine the efficacy of radiofrequency lumbar facet joint denervation. In both groups, there was significant improvement in the Visual Analog Scale (VAS) [23]. In the Mint study, three randomized clinical trials were conducted on the effectiveness of minimal interventional treatments for participants with chronic low back pain. Radiofrequency denervation combined with a standardized exercise program resulted in either no improvement or no clinically important improvement in chronic low back pain compared with a standardized exercise program alone. In another randomized control trial, assessing the efficacy of Radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain the authors stated that they did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia at 6 months follow-up. The need for pain medication did not differ significantly between groups [24]. In another randomized controlled trial, in patients with cervicogenic headache the authors did not find evidence that radiofrequency treatment of cervical facet joints was a better treatment than the infiltration of the greater occipital nerve [25].

In one study the author stated that the evidence is poor for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections. These can be fatal and include vertebral artery injury, systemic allergic reactions to radio contrast agents, transient cortical blindness and brain injury [26], stroke, paraplegia, quadriplegia, spinal cord and cerebella infarction [27,28].

These trials raise the issue of questionable benefits, compared to simpler procedures such as our myofascial nerve blockade.