End-on Versus Parallel Radiofrequency Lesioning for Neurotomy of the Cervical Medial Branch Nerves

NCT ID: NCT05818774

Last Updated: 2024-12-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

72 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-10

Study Completion Date

2027-03-31

Brief Summary

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Aim of the EndPaRL study is to compare the efficacy and effectiveness of the two techniques utilizing sharp straight conventional radiofrequency needle with a trident needle for radiofrequency neurotomy of Cervical Medial Branch Nerves (CMBNs), in patients presenting with chronic, moderate-to-severe, neck pain due to cervical zygapophyseal joint osteoarthritis, as diagnosed by positive responses to two consecutive diagnostic blocks with local anesthetic of the CMBN.

Detailed Description

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Conditions

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Neck Pain Zygapophyseal Joint Arthritis

Keywords

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Radiofrequency neurotomy Cervical Medial Branch Nerves

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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RFN of CMBNn with end-on lesioning with multitIned trident cannulae

Intervention type: RF nerve end-on lesioning at 80-850 Celsius for 90 seconds

Intervention name: End-on placement of the multitined trident cannulae

Intervention description:

Patient in lateral position, targeting joint position between the inferior C2 and superior C3 facets, the middle of the facet pillars for the third to fifth cervical levels, and the superior part of the sixth and seventh cervical facets

Group Type EXPERIMENTAL

Radiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with end-on lesioning with multitined trident cannulae

Intervention Type PROCEDURE

Intervention type: RF nerve lesioning lesioning at 80-850 Celsius for 90 seconds Intervention name: End-on placement of the multitined trident cannulae

Intervention description:

Patient in lateral position, targeting joint position between the inferior C2 and superior C3 facets, the middle of the facet pillars for the third to fifth cervical levels, and the superior part of the sixth and seventh cervical facets.

RFN of CMBNn with parallel lesioning with sharp straight conventional cannulae (SIS's technique)

Intervention type: RF nerve parallel lesioning at 80-850 Celsius for 90 seconds

Intervention name: Straight sharp conventional (SIS's technique)

Intervention description:

Technique as described in the SIS Practice Guidelines for parallel lesioning cannulae placement

Group Type ACTIVE_COMPARATOR

Radiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with parallel lesioning

Intervention Type PROCEDURE

Intervention type: RF nerve lesioning at 80-85 degree Celsius for 90 seconds Intervention name: Straight sharp conventional (SIS's technique)

Intervention description:

Technique as described in the SIS Practice Guidelines for parallel lesioning cannulae placement

Interventions

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Radiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with parallel lesioning

Intervention type: RF nerve lesioning at 80-85 degree Celsius for 90 seconds Intervention name: Straight sharp conventional (SIS's technique)

Intervention description:

Technique as described in the SIS Practice Guidelines for parallel lesioning cannulae placement

Intervention Type PROCEDURE

Radiofrequency neurotomy (RFN) of Cervical Medial Branch Nerves (CMBNn) with end-on lesioning with multitined trident cannulae

Intervention type: RF nerve lesioning lesioning at 80-850 Celsius for 90 seconds Intervention name: End-on placement of the multitined trident cannulae

Intervention description:

Patient in lateral position, targeting joint position between the inferior C2 and superior C3 facets, the middle of the facet pillars for the third to fifth cervical levels, and the superior part of the sixth and seventh cervical facets.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Adult patient of either gender aged 18-85 years
2. Predominant axial (non-radicular) neck pain for at least 3 months
3. 7-day average NRS score for neck pain ≥ 5/10 at baseline evaluation
4. Moderate or greater functional impairment due to pain, defined as NDI Questionnaire raw score of 15 out of 50 (≥30% )e Failure to respond to conservative medical management (pharmacologic, physical therapy) for at least 3 months;

f) Positive response to two consecutive diagnostic blocks of the CMBN with a short and long-acting anesthetic

Exclusion Criteria

1. Participants with financial incentives or litigation associated with ongoing pain
2. Inability to complete assessment instruments
3. Chronic widespread pain
4. Prior RFN of the CMBN;
5. Severe mental health issues
6. Pregnancy or other reason that precludes the use of fluoroscopy
7. Untreated coagulopathy
8. Systemic or local infection at the time of screening.
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Health Network, Toronto

OTHER

Sponsor Role lead

Responsible Party

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Anuj Bhatia

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anuj Bhatia, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesia and Pain Management, University Health Network, Toronto

Locations

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Women's College Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

University Health Network (UHN)

Toronto, Ontario, Canada

Site Status RECRUITING

Division of Pain Medicine, Department of Anesthesiology, Reanimation, and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona.

Barcelona, Catalonia, Spain

Site Status NOT_YET_RECRUITING

Countries

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Canada Spain

Central Contacts

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Danielle Alvares, PhD

Role: CONTACT

Phone: (416) 603-5800

Email: [email protected]

Facility Contacts

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Anuj Bhatia

Role: primary

Didem Bozak

Role: backup

Danielle Alvares, PhD

Role: primary

Guilherme Ferreira Dos Santos, MD

Role: primary

References

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Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996 Dec 5;335(23):1721-6. doi: 10.1056/NEJM199612053352302.

Reference Type BACKGROUND
PMID: 8929263 (View on PubMed)

Barnsley L. Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients. Pain Med. 2005 Jul-Aug;6(4):282-6. doi: 10.1111/j.1526-4637.2005.00047.x.

Reference Type BACKGROUND
PMID: 16083457 (View on PubMed)

MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012 May;13(5):647-54. doi: 10.1111/j.1526-4637.2012.01351.x. Epub 2012 Mar 28.

Reference Type BACKGROUND
PMID: 22458772 (View on PubMed)

Alomari A, Ferreira-Dos-Santos G, Singh M, Burnham T, Cao X, McCormick Z, Flamer D, Kumar P, Hoydonckx Y, Khan JS, Tumber PS, Alvares D, Bhatia A. End-on versus parallel radiofrequency lesioning for neurotomy of the cervical medial branch nerves: a study protocol of a prospective, randomized, double-blind clinical trial: the "EndPaRL" study. Trials. 2023 Nov 11;24(1):721. doi: 10.1186/s13063-023-07752-9.

Reference Type DERIVED
PMID: 37951900 (View on PubMed)

Other Identifiers

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22-5634

Identifier Type: -

Identifier Source: org_study_id