Current trends in the technical performance of lumbar zygapophyseal joint interventions.

Objective: To survey how interventional pain physicians are currently performing lumbar facet interventions, with an emphasis on fellowship training.

Design: Survey Study.

Methods: An online electronic survey disseminated via Research Electronic Data Capture (REDCap) software to current and expired attending physician members of the Spine Intervention Society (SIS). Responses were stratified by fellowship training type: ACGME Pain Medicine (APM), ACGME Sports Medicine (ASM), Interventional Spine and Musculoskeletal Medicine (ISMM), or None.

Results: As a whole, a majority of respondents indicated on independent questions they require 2 diagnostic medial branch blocks (MBBs) performed with 0.5 ​cc or less of anesthetic to result in at least 75% pain relief before proceeding with a radiofrequency neurotomy (RFN), performed via parallel approach with 18g or larger needle and 10 ​mm active tip and a lesion of at least 80-85° C and 90-119 ​s of duration. Statistically significant differences as stratified by APM vs ISMM fellowship training included: the use of corticosteroids at the time of RFN (43/79 (54.4%) vs 16/63 (25.4%), typically treating 3 segments or more 22/79 (27.8%) vs 7/73 (9.6%), and MBB volume injectate of 1 ​cc 22/79 (27.8%) vs 7/63 (11.1%) respectively.

Conclusions: There is largely agreement upon the technical performance of lumbar facet interventions by members of SIS. Physicians who completed an APM fellowship were more likely to report using corticosteroids at the time of RFN, using higher anesthetic volumes and treating 3 or more spinal segments.