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Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough?

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Abstract

Objective

Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy.

Methods

We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software.

Results

A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1 year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = −0.87, 95% confidence interval (CI) [−2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = −0.13, 95%CI [−0.18, −0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0 .0001).

Conclusion

The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness.

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References

  1. Böning G, Hartwig T, Freyhardt P, de Bucourt M, Teichgräber U, Streitparth F (2021) MR-guided lumbar facet radiofrequency denervation for treatment of patients with chronic low back pain in an open 1.0 Tesla MRI system. Ann Transl Med 9(13):1056. https://doi.org/10.21037/atm-21-633

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chen YS, Liu B, Gu F, Sima L (2022) Radiofrequency denervation on lumbar facet joint pain in the elderly: a randomized controlled prospective trial. Pain Phys 25(8):569–576

    Google Scholar 

  3. Civelek E, Cansever T, Kabatas S, Kircelli A, Yilmaz C, Musluman M, Ofluoglu D, Caner H (2012) Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain. Turk Neurosurg 22(2):200–206. https://doi.org/10.5137/1019-5149.JTN.5207-11.1

    Article  PubMed  Google Scholar 

  4. Conger A, Burnham T, Salazar F, Tate Q, Golish M, Petersen R, Cunningham S, Teramoto M, Kendall R, McCormick ZL (2020) The Effectiveness of radiofrequency ablation of medial branch nerves for chronic lumbar facet joint syndrome in patients selected by guideline-concordant dual comparative medial branch blocks. Pain Med 21(5):902–909. https://doi.org/10.1093/pm/pnz248

    Article  PubMed  Google Scholar 

  5. Cosman ER Jr, Dolensky JR, Hoffman RA (2014) Factors that affect radiofrequency heat lesion size. Pain Med 15(12):2020–2036. https://doi.org/10.1111/pme.12566

    Article  PubMed  Google Scholar 

  6. Curtis L, Shah N, Padalia D (2023) Facet joint disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

  7. Du T, Lu G, Li J, Ni B, Shu W, Sun T, Yang D, Zhu H (2022) Pain-free survival after endoscopic rhizotomy versus radiofrequency for lumbar facet joint pain: a real-world comparison study. Pain Phys 25(1):E87–E94

    Google Scholar 

  8. Juch JNS, Maas ET, Ostelo RWJG, Groeneweg JG, Kallewaard JW, Koes BW, Verhagen AP, van Dongen JM, Huygen FJPM, van Tulder MW (2017) Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the mint randomized clinical trials. JAMA 318(1):68–81. https://doi.org/10.1001/jama.2017.7918

    Article  PubMed  PubMed Central  Google Scholar 

  9. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  Google Scholar 

  10. Kapetanakis S, Gkantsinikoudis N (2021) Anatomy of lumbar facet joint: a comprehensive review. Folia Morphol (Warsz) 80(4):799–805. https://doi.org/10.5603/FM.a2020.0122

    Article  CAS  PubMed  Google Scholar 

  11. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021) Low back pain. Lancet 398(10294):78–92. https://doi.org/10.1016/S0140-6736(21)00733-9

    Article  PubMed  Google Scholar 

  12. Lakemeier S, Lind M, Schultz W, Fuchs-Winkelmann S, Timmesfeld N, Foelsch C, Peterlein CD (2013) A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg 117(1):228–235. https://doi.org/10.1213/ANE.0b013e3182910c4d

    Article  CAS  PubMed  Google Scholar 

  13. Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M (2001) Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 26(13):1411–1416. https://doi.org/10.1097/00007632-200107010-00003

    Article  CAS  PubMed  Google Scholar 

  14. Moussa WM, Khedr W (2016) Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome. Clin Neurol Neurosurg 150:96–104. https://doi.org/10.1016/j.clineuro.2016.09.004

    Article  PubMed  Google Scholar 

  15. Moussa WM, Khedr W, Elsawy M (2020) Percutaneous pulsed radiofrequency treatment of dorsal root ganglion for treatment of lumbar facet syndrome. Clin Neurol Neurosurg 199:106253. https://doi.org/10.1016/j.clineuro.2020.106253

    Article  PubMed  Google Scholar 

  16. Ochiai N, Tasto JP, Ohtori S, Takahashi N, Moriya H, Amiel D (2007) Nerve regeneration after radiofrequency application. Am J Sports Med 35(11):1940–1944. https://doi.org/10.1177/0363546507304175

    Article  PubMed  Google Scholar 

  17. Paulsen RT, Carreon L, Busch F, Isenberg-Jørgensen A (2019) A pilot cohort study of lumbar facet joint denervation in patients with chronic low-back pain. Dan Med J 66(3):A5533

    PubMed  Google Scholar 

  18. Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, Heck O, Boubagra K, Grand S, Krainik A (2018) Facet joint syndrome: from diagnosis to interventional management. Insights Imaging 9(5):773–789. https://doi.org/10.1007/s13244-018-0638-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Provenzano DA, Buvanendran A, de León-Casasola OA, Narouze S, Cohen SP (2018) Interpreting the MINT randomized trials evaluating radiofrequency ablation for lumbar facet and sacroiliac joint pain: a call from ASRA for better education, study design, and performance. Reg Anesth Pain Med 43(1):68–71. https://doi.org/10.1097/AAP.0000000000000699

    Article  PubMed  Google Scholar 

  20. Provenzano DA, Watson TW, Somers DL (2015) The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size. Reg Anesth Pain Med 40(2):112–124. https://doi.org/10.1097/AAP.0000000000000207

    Article  PubMed  Google Scholar 

  21. Sakuma Y, Ohtori S, Miyagi M, Ishikawa T, Inoue G, Doya H, Koshi T, Ito T, Yamashita M, Yamauchi K, Suzuki M, Moriya H, Takahashi K (2007) Up-regulation of p55 TNF alpha-receptor in dorsal root ganglia neurons following lumbar facet joint injury in rats. Eur Spine J 16(8):1273–1278. https://doi.org/10.1007/s00586-007-0365-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shuang F, Hou SX, Zhu JL, Liu Y, Zhou Y, Zhang CL, Tang JG (2015) Clinical anatomy and measurement of the medial branch of the spinal dorsal ramus. Medicine 94(52):e2367. https://doi.org/10.1097/MD.0000000000002367

    Article  PubMed  PubMed Central  Google Scholar 

  23. Song K, Li Z, Shuang F, Yin X, Cao Z, Zhao H, Qin J, Li Z (2019) Comparison of the effectiveness of radiofrequency neurotomy and endoscopic neurotomy of lumbar medial branch for facetogenic chronic low back pain: a randomized controlled trial. World Neurosurg 126:e109–e115. https://doi.org/10.1016/j.wneu.2019.01.251

    Article  PubMed  Google Scholar 

  24. Starr JB, Gold L, McCormick Z, Suri P, Friedly J (2019) Trends in lumbar radiofrequency ablation utilization from 2007 to 2016. Spine J 19(6):1019–1028. https://doi.org/10.1016/j.spinee.2019.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  25. Suer M, Wahezi SE, Abd-Elsayed A, Sehgal N (2022) Cervical facet joint pain and cervicogenic headache treated with radiofrequency ablation: a systematic review. Pain Phys 25(3):251–263

    Google Scholar 

  26. Thanos L, Mylona S, Kalioras V, Pomoni M, Batakis N (2004) Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience). Eur J Radiol 50(3):273–277. https://doi.org/10.1016/j.ejrad.2004.01.024

    Article  PubMed  Google Scholar 

  27. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S (1999) Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 24(18):1937–1942. https://doi.org/10.1097/00007632-199909150-00013

    Article  PubMed  Google Scholar 

  28. van Tilburg CW, Stronks DL, Groeneweg JG, Huygen FJ (2016) Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain. Bone Joint J 98-B(11):1526–1533. https://doi.org/10.1302/0301-620X.98B11.BJJ-2016-0379.R2

    Article  PubMed  Google Scholar 

  29. van Wijk RM, Geurts JW, Wynne HJ, Hammink E, Buskens E, Lousberg R, Knape JT, Groen GJ (2005) Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain 21(4):335–344. https://doi.org/10.1097/01.ajp.0000120792.69705.c9

    Article  PubMed  Google Scholar 

  30. Walter SG, Schildberg FA, Rommelspacher Y (2018) Endoscopic sacrolumbar facet joint denervation in osteoarthritic and degenerated zygapophyseal joints. Arthrosc Tech 7(12):e1275–e1279. https://doi.org/10.1016/j.eats.2018.08.014

    Article  PubMed  PubMed Central  Google Scholar 

  31. Woiciechowsky C (2022) Comparison of endoscopic facet joint denervation to the percutaneous technique regarding efficacy in patients with low back pain: a randomized controlled trial. Spine 47(17):1187–1193. https://doi.org/10.1097/BRS.0000000000004392

    Article  PubMed  Google Scholar 

  32. Woiciechowsky C, Richter LM (2020) Endoscopic 4 MHz radiofrequency treatment of facet joint syndrome is more than just denervation: one incision for three facets. J Neurol Surg A Cent Eur Neurosurg 81(3):238–242. https://doi.org/10.1055/s-0039-1698397

    Article  PubMed  Google Scholar 

  33. Xue Y, Ding T, Wang D, Zhao J, Yang H, Gu X, Feng D, Zhang Y, Liu H, Tang F, Wang W, Lu M, Wu C (2020) Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain. J Orthop Surg Res 15(1):4. https://doi.org/10.1186/s13018-019-1533-y

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zhou Q, Zhou F, Wang L, Liu K (2016) An investigation on the effect of improved X-rays-guided radiofrequency thermocoagulation denervation on lumbar facet joint syndrome. Clin Neurol Neurosurg 148:115–120. https://doi.org/10.1016/j.clineuro.2016.07.018

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Science and Technology Innovation Foundation of Dalian (2022JJ12SN045) and the Natural Science Foundation of Liaoning Province (2022-MS-322). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People’s Republic of China

    Ruihuan Du, Bo Wang, Jing Zhang, Meng Meng, Jingzuo wang, Wentao Qu & Zhonghai Li

  2. Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China

    Jing Gao

  3. Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, Liaoning, People’s Republic of China

    Zhonghai Li

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  1. Ruihuan Du
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Contributions

DRH and GJ were responsible for the conception and design; DRH, GJ, WB, and LZH were responsible for manuscript writing and revision; DRH, ZJ, MM, WJZ, QWT, and LZH participated in the data analysis; and all authors read and approved the final manuscript.

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Correspondence to Zhonghai Li.

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Du, R., Gao, J., Wang, B. et al. Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough?. Eur Spine J 33, 463–473 (2024). https://doi.org/10.1007/s00586-023-08078-5

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