The effectiveness of radiofrequency denervation of medial branch nerve in the treatment of facet mediated low back pain in adults. A prospective interventional study.

Athorough pre anaesthetic evaluation will be done 24 hours prior to theprocedure. All patients will be assigned to LFJ intraarticular PRP injection orRFA of medial branch nerve. The evaluation of the enrolled patients will bedone by experienced Orthopedician and the diagnosis will be based on physicalexamination, radio imaging (MRI) and diagnostic block of L3/L4-L5/S1 LFJ with 0.5%Bupivacaine.  Standard monitoring with electrocardiography(ECG), automated NIBP (noninvasive blood pressure), and pulse oximetry (SpO2) will be done for intraoperative monitoring.

Randomization of the participants into two groups iddone by using sealed shuffled opaque envelope technique.

 Participants will be divided into two groups:-

GROUP 1:-Those who are receiving intraarticular PRPinjections

GROUP 2:- Those who are receiving RFA of medial branchnerve

 This will be a double blindedstudy. In both groups, all procedures will be performed by the same experiencedpain physician. The only unblinded personnel in this study is the primary painphysician. Patients will be unblinded after the 6 months follow up or ifrequested before that time.

 Intraarticular Diagnostic blocks:

Patients in prone position, underfluoroscopy and under strict aseptic conditions, a 22G needle is inserted untilit is contacted at the edge of the LFJ. Adequate needle positioning isconfirmed by injecting 0.3 to 0.5ml of contrast. Once position is confirmed, 1mlof 0.5% bupivacaine is injected into LFJ.

 Radiofrequency Denervation:

All RFA procedures areperformed under fluoroscopic guidance. Patients in prone position, underaseptic conditions, 20G curved 100mm RF needles with active tips are placed atthe site of the dorsal ramus medial branch of the relevant L3/L4-L5/S1 LFJ’s.Correct placement is confirmed using electrostimulation at 50 HZ for sensoryand 2HZ for motor functions. Then 0.5% bupivacaine is injected through cannulato decrease procedure related pain. The RF probe is then reinserted into thecannula and lesioning at a temperature of 80℃ for 90 seconds using RFgenerator. Then, inj.dexamethasone 4mg is injected to prevent post operativeneuritis.