The causes of chronic spinal pain may be disc disorders, stenosis, spondyliolisthesis, instability, osteoporosis, and sacroiliac joint disorder. However, about 20% are known to be due to facet joints and surrounding structures.
Although the term "facet syndrome" has not been widely accepted as a true clinical entity, it is gaining a popularity for one of the common causes of chronic spinal disorders because it represents not only the facet joint dysfunction but also any structure abnormalities that cause the irritation and painful reaction of the nerves supplying facet joints, paravertebral muscles, and ihterspinous ligaments which all together are the major anatomical structures that may be associated with acute or chronic back pain syndromes. This nerve is medial branch of posteriorramus and is known as one of final common pathways of low back pain. Thus, whenever the causes of low back pain is speculated due to irritation of this nerve, the optimal therapeutic approach is to block this pathway to ascending pain pathway. Clinically, diagnostic block on this nerve may provide more clear picture to confirm its diagmosis because there has not been successful clinical and/or radiographic and therapeutic nerve block procedures are routinely recommended for the evaluation of its presence and the outcome. When there needs to be more than three times of therapeutic nerve blocks, radiofrequency (RF) lesioning on this nerve (radiofrequency facetrhizotomy or medial branch neurotomy) may be performed for the long term pain relief whthout any significant side effects or complications. At present, previous conventional heat producing radiofrequency lesionging is still commonly performed but recently introduced a new technique of radiofrequency lesioning, the pulsed type radiofrequency, can also be an option whenever there is a fear of causing or adding neuropathic pain because it does not produce any harmful heat (42 celcius degrees only) and its mechanisms of action are different from conventional RF thchnique. Here, it is intended to introduce the types and thchniques of RF technique for the management of chronic spinal pain, mainly focused on the RF treatment targeted on the medial branch of posterior primary ramus.