Radiofrequency Ablation for Lumbar Spondylosis

Clinical Assessment and Indications

The patient has chronic axial low back pain for greater than 3 years with recent exacerbation, and pain reproducible with facet loading, which is consistent with facet-mediated pain 1, 2
Conservative treatments, including medications such as NSAIDs, gabapentin, and methocarbamol, and a home exercise program, have been attempted without benefit 2
Therapeutic injections, including bilateral L4-L5 transforaminal epidural injections, have provided resolution of radicular complaints but persistent axial pain 1

Clinical practice guidelines support RFA for facet-mediated low back pain when the patient has experienced severe pain limiting activities of daily living, and conservative treatments have been tried and failed 1, 2
The pain being reproducible with facet loading maneuvers, and the patient having previously responded well to RFA with significant pain relief, are also indicators for RFA 1, 2
For repeat procedures, guidelines indicate that RFA is medically necessary when the patient obtained greater than 50% pain relief for at least twelve weeks from the previous RFA, and the procedure is performed at intervals of at least six months per level per side 1

The requested procedure involves radiofrequency ablation of the lumbar facet joints, which is appropriate for this patient's clinical presentation 1

The strongest evidence supports the use of RFA in patients who have previously responded well to the procedure, such as this patient with a history of 90% relief for 2 years 2, 3
The patient does not have any contraindications to the procedure, such as prior spinal fusion surgery at the levels to be treated 1