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Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials

  • Musculoskeletal Radiology
  • Published:
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Abstract

Background

Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control.

Materials and methods

A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months).

Results

Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD − 1.01; 95% CI − 1.98 to -0.04; p = 0.04), medium (MD − 1.42; 95% CI − 2.41 to − 0.43; p = 0.005), and long term (MD − 1.12; 95% CI − 1.57 to − 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD − 0.94; 95% CI − 1.73 to − 0.14; p = 0.02) and long term (SMD − 0.74; 95% CI − 1.09 to − 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07–0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06–0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection.

Conclusions

RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.

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Data availability statement

All data are available upon reasonable request to the corresponding author.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain

    Antonio Jesús Láinez Ramos-Bossini & Fernando Ruiz Santiago

  2. Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain

    Antonio Jesús Láinez Ramos-Bossini, Paula María Jiménez Gutiérrez & Fernando Ruiz Santiago

  3. Department of Anesthesiology, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain

    Paula María Jiménez Gutiérrez

  4. Department of Radiology and Physical Medicine, University of Granada, Granada, Spain

    Fernando Ruiz Santiago

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AJLRB and PMJG. The first draft of the manuscript was written by AJLRB and revised by FRS. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Antonio Jesús Láinez Ramos-Bossini.

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This is a meta-analysis of previously published data. The Provincial Ethics Committee of Granada has confirmed that no ethical approval is required.

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11547_2024_1809_MOESM1_ESM.png

Supplementary File 1. Subgroup analysis based on the duration of low back pain as an inclusion criterion. Top row, Pain in the short (left), medium (center) and long (right) term. Bottom row, Functional status in the short (left), medium (center) and long (right) term. Supplementary file1 (PNG 1725 KB)

11547_2024_1809_MOESM2_ESM.jpg

Supplementary File 2. Subgroup analysis based on having performed magnetic resonance imaging as an inclusion criterion. Top row, Pain in the short (left), medium (center) and long (right) term. Bottom row, Functional status in the short (left), medium (center) and long (right) term. Supplementary file2 (JPG 1384 KB)

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Supplementary file4 (JPG 190 KB)

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Láinez Ramos-Bossini, A.J., Jiménez Gutiérrez, P.M. & Ruiz Santiago, F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. Radiol med 129, 794–806 (2024). https://doi.org/10.1007/s11547-024-01809-8

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