Clinical Outcomes of Conventional Versus Lateral-Deployment RF Cannulas in Lumbar Medial Branch Radiofrequency Ablation

Objective: To compare conventional monopolar and lateral-deployment RF cannulas for lumbar medial branch radiofrequency ablation (RFA) in chronic facet-mediated low back pain. Design: Single-center, randomized, participant-blinded, two-arm superiority trial. Ninety participants were randomized 1:1; 84 with complete 6-month data were analyzed. The primary outcome was change in Numeric Rating Scale (NRS) pain intensity from baseline to 6 months. Secondary outcomes were changes in the Modified Oswestry Disability Index (MODI) and SF-12 Physical (PCS) and Mental (MCS) Component Scores. Results: Mean NRS change was −2.81 points with the conventional cannula and −5.52 points with the lateral-deployment cannula. The age-adjusted between-group difference was −2.795 points (95% CI, −3.967 to −1.624; P <0.001). At 6 months, at least 50% NRS reduction was achieved by 16/42 (38.1%) and 31/42 (73.8%) participants, respectively (risk ratio, 1.94; 95% CI, 1.27–2.97; P =0.001). Age-adjusted MODI and SF-12 PCS changes favored the lateral-deployment cannula. No major procedure-related complications were observed. Conclusion: The lateral-deployment cannula was associated with greater 6-month improvements in pain, disability, and physical health and with more participants achieving substantial pain relief. Larger trials with intention-to-treat analyses are needed.