Facet Joints Related Pain and Radiofrequency Denervation
Low back pain affects 60 per cent to 80 per cent of people worldwide. One of the sources of back pain can be the facet joints of the spine. They have been implicated in up to 15 per cent to 45 per cent of back pain cases. Facet joint-related symptoms could be presented with lumbar pain radiating down toward the buttock and posterior thigh.
FJRD (Facet joint radiofrequency denervation) for the treatment of facet joint related pain was first described in 1975 and has been used in as a minimally invasive procedure for pain relief. Radiofrequency denervation for the treating facet joints uses energy in the radiofrequency range to kill off specific nerves that innervate the facet joint, blocking the transmission of pain. The purpose of FJRD is for pain relief and decrease the possibility of recurrence. This study was a systematic review, meaning that it examined past studies done on radiofrequency denervation for facet joint pain. The systematic review assessed the treatment effects of FJRD for patients with facet joint related chronic LBP. Pain, quality of life, cost-effectiveness and complications were some of the outcomes examined. Studies are searched based on certain criteria and then narrowed down to the most applicable. The initial search found 329 studies and through the filtering process nine were considered to be acceptable studies to review.
Pain reduction was demonstrated with most studies assessed in this review. Meta-analysis also suggested that there was a benefit in pain control with FJRD up to one year after the intervention.
Results for functional status improvement favored FJRD against placebo. Only one study suggested that better results were obtained for radiofrequency then for a steroid injection but the study did not use a measurement device that had been validated. There was no significant difference for quality of life through the studies examined.
There were no comparisons for cost-effectiveness of FJRD against physical therapy or steroid injection.
The available evidence reviewed in this study should be read with caution. Most studies complied for this review had low to moderate methodological quality, only a few evaluated functional status, quality of life with validated scales and none controlled for other health factors. Findings indicated that FJRD is more effective then placebo in pain control and functional improvement. Comparing FJRD to steroid injections was inconclusive and it is possible that FJRD is more effective the steroid injections for pain control. Complications and adverse effects were not reported sufficiently to accurately compare. Cost-effectiveness was not examined in any studies, so no evidence is available.
Arthur Werner Poetscher, MD, Msc. et al. Radiofrequency Denervation for Facet Joint Low Back Pain. In Spine. June 2014. Vol. 39. No. 14. Pp. E842-E849.