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Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis
  1. Soyoon Park1,
  2. Ji-Hoon Park2,
  3. Ni Sokpeou3,
  4. Jae Ni Jang1,
  5. Young Uk Kim1,
  6. Young-Soon Choi1 and
  7. Sukhee Park1
  1. 1Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
  2. 2Department of Anesthesiology and Pain Medicine, Keimyung University College of Medicine, Daegu, Korea (the Republic of)
  3. 3Anesthesiology, Intensive Care and Emergency Medicine, Hebron Medical Center, Phnom Penh, Cambodia
  1. Correspondence to Dr Sukhee Park; appealex{at}gmail.com

Abstract

Background Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial.

Objective We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA).

Evidence review A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method.

Findings The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency.

Conclusions This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations.

PROSPERO registration number CRD42024524657.

  • Analgesia
  • Back Pain
  • Injections, Spinal
  • Meta-Analysis
  • Pain Management

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Footnotes

  • SP and J-HP are joint first authors.

  • Contributors SoyoonP: study design, protocol registration, drafting the manuscript. J-HP: study design, protocol registration, data analysis/interpretation, drafting the manuscript, final manuscript approval. NS, JNJ, and Y-SC: screening, data extraction, drafting manuscript. YUK: data analysis/interpretation, final manuscript approval. SukheeP: study design, protocol registration, screening, data extraction, data analysis/interpretation, drafting the manuscript, funding acquisition.

  • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government Ministry of Science and ICT (grant number: 2022R1F1A1068925).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.