Journal of Pain Research (Sep 2021)
Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis
Abstract
Rajesh N Janapala,1 Laxmaiah Manchikanti,2– 4 Mahendra R Sanapati,5,6 Srinivasa Thota,5 Alaa Abd-Elsayed,7 Alan D Kaye,8,9 Joshua A Hirsch10 1School of Medicine and Health Sciences, George Washington University, Washington, DC, USA; 2Pain Management Centers of America, Paducah, KY, USA; 3Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA; 4Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA; 5Pain Management Centers of America, Evansville, IN, USA; 6Anesthesiology and Research, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA; 7UW Health Pain Services, and Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 8Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Sciences Center, Shreveport, LA, USA; 9Ochsner Shreveport Hospital and Pain Clinic Feist-Weiller Cancer Center, Shreveport, LA, USA; 10Neurointerventional Radiology and Spine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USACorrespondence: Laxmaiah ManchikantiPain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USATel +1 270 554 8373Fax +1 270 554 8987Email [email protected]: The objective of the systematic review and meta-analysis is to evaluate the efficacy of radiofrequency neurotomy as a therapeutic lumbar facet joint intervention.Patients and Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a systematic review and meta-analysis was performed. A comprehensive literature search of multiple data sources from 1966 to September 2020 including manual searches of bibliography of known review articles was performed. The inclusion criteria were based on the selection of patients with chronic low back pain with diagnosis confirmed based on controlled diagnostic blocks and with the publication of at least 6 months of results of appropriate outcome parameters. Quality assessment of the trials was performed with Cochrane review criteria and interventional pain management techniques-quality appraisal of reliability and risk of bias assessment (IPM-QRB). The level of evidence of effectiveness is classified at five levels ranging from Level I to Level V. The primary outcome measure was a significant reduction in pain, eg, short term (up to 6 months) and long term (more than 6 months). The secondary outcome measure was an improvement in functional status.Results: A total of 12 randomized controlled trials (RCTs) met the inclusion criteria for evaluating the efficacy of lumbar radiofrequency neurotomy. Radiofrequency neurotomy showed Level II evidence for efficacy for both the short term and long term.Conclusion: This systematic review of the assessment of the efficacy of radiofrequency neurotomy in managing chronic low back pain was based on the inclusion of 12 RCTs with a diagnostic block and at least 6 months of follow-up results that showed Level II evidence for both short-term and long-term improvement.Keywords: diagnostic facet joint nerve blocks, facet joint pain, facet joint nerve blocks, randomized trials, radiofrequency neurotomy, systematic review, meta-analysis
