Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Janapala, Rajesh Naidu; Manchikanti, Laxmaiah; Sanapati, Mahendra R; Thota, Srinivasa; Abd‐Elsayed, Alaa; Kaye, Alan D.; Hirsch, Joshua A

doi:10.2147/jpr.s323362

Cited by 18 publications

(11 citation statements)

References 86 publications

(277 reference statements)

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“…A systematic review and meta-analysis were performed on the basis of methodological and reporting quality of systematic reviews as described by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [60,61]. Methodology from other reviews was also utilized [62,63].…”

Section: Methodsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

et al. 2022

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Background Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks. Study Design Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis. Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain. Methods Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined. Results Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is level II in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was level III to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions. Limitations There was a paucity of literature and heterogeneity among the available studies. Conclusion This systematic review and meta-analysis shows level II evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with level III to IV evidence in managing cervicogenic headaches. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00455-0.

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Section: Methodsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

et al. 2022

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“…Chen et al 128 demonstrated the effective application of radiofrequency neurotomy on facetogenic chronic LBP via a meta-analysis. Janapala et al 129 reported a systematic review and meta-analysis including 12 randomized controlled trials, and they found that the short-term and long-term efficacy of lumbar radiofrequency neurotomy were debated. Al-Najjim et al 130 conducted a systematic review including 4 studies with randomized controlled trials, which compared the outcome of radiofrequency denervation compared to sham or placebo procedures for the treatment of facetogenic LBP.…”

Section: Managementmentioning

confidence: 99%

Section: Medial Branch Radiofrequency Ablationmentioning

confidence: 99%

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment

Du¹,

Xu²,

Bai³

2022

JPR

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Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.

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“…The transmission of nociceptive impulses is blocked by applying an electric current to coagulate the sensory nerves, which deactivates the nerves (2). A recent systematic review supported the superiority of conventional radiofrequency (CRF) over sham controls and other treatments in terms of short-term (≤6 months) and long-term (>6 months) improvement (5). However, there has been no systematic review of the effectiveness evaluation of other emerging RF denervation treatments, such as pulsed RF denervation, RF facet capsule denervation, and RF ablation under endoscopic guidance.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of radiofrequency denervation in chronic low back pain: A systematic review and network meta-analysis

Zhang

et al. 2022

Front. Surg.

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BackgroundFacet joint pain is a common cause of chronic low back pain (CLBP). Radiofrequency (RF) denervation is an effective treatment option.PurposeA systematic review and network meta-analysis (NMA) was performed to evaluate and compare the efficacy and effectiveness of different RF denervation treatments in managing facet joint-derived CLBP.MethodsThe Cochrane Library, Embase, PubMed, and China Biology Medicine were searched to identify eligible randomized controlled trials (RCTs) from January 1966 through December 2021. Interventions included conventional radiofrequency denervation (CRF), pulsed radiofrequency denervation (PRF), pulsed radiofrequency treatment of the dorsal root ganglia (PRF-DRG), radiofrequency facet capsule denervation (RF-FC), and radiofrequency ablation under endoscopic guidance (ERFA). The outcome was the mean change in visual analog scale (VAS) score from baseline. A random-effects NMA was used to compare the pain relief effects of the interventions over the short term (≤6 months) and long term (12 months). The rank of effect estimation for each intervention was computed using the surface under the cumulative ranking curve.ResultsA total of 10 RCTs with 715 patients met the inclusion criteria. Moderate evidence indicated that CRF denervation had a greater effect on pain relief than sham control in the short term (standardized mean difference (SMD) −1.58, 95% confidence intervals (CI) −2.98 to −0.18) and the long term (SMD −4.90, 95% CI, −5.86 to −3.94). Fair evidence indicated that PRF denervation was more effective than sham control for pain over the long term (SMD −1.30, 95% CI, −2.17 to −0.43). Fair evidence showed that ERFA denervation was more effective for pain relief than sham control in the short term (SMD −3.07, 95% CI, −5.81 to −0.32) and the long term (SMD −4.00, 95% CI, −4.95 to −3.05). Fair evidence showed that RF-FC denervation was more effective for pain relief than sham control in the long term (SMD −1.11, 95% CI, −2.07 to −0.15). A fair level of evidence indicated that PRF-DRG denervation was more effective for pain relief than sham control in the short term (SMD −5.34, 95% CI, −8.30 to −2.39).ConclusionRF is an effective option for patients diagnosed with facet joint-derived CLBP.Systematic Review Registration: Identifier: CRD42022298238.

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Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 86 publications

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment

Comparative efficacy of radiofrequency denervation in chronic low back pain: A systematic review and network meta-analysis

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