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Le VT, Bui DTH, Do PT. Prospective study on a new combination of pulsed radiofrequency and platelet-rich plasma injections for managing grade I lumbosacral spondylolisthesis. Sci Rep 2025; 15:1451. [PMID: 39789111 PMCID: PMC11718092 DOI: 10.1038/s41598-024-84614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/25/2024] [Indexed: 01/12/2025] Open
Abstract
Our study aimed to investigate the clinical benefits of combining pulsed radiofrequency (PRF) and platelet-rich plasma (PRP) techniques for treating chronic lumbosacral radicular (CLSR) pain resulting from grade I spondylolisthesis (G1SL). Ninety-six patients with CLSR pain between March 2021 and March 2023 were included in this study, 58 patients with G1SL without instability on dynamic radiographs - Group A and 38 patients with instability - Group B. Pre-procedure, Group B had higher pain levels than Group A. Post-procedure and at follow-up intervals, Visual Analog Scale (VAS) pain scores improved in both groups (p < 0.05) and there were no significant differences between the groups. Both groups also showed significant improvement in ODI scores post-procedure, which was maintained at follow-up intervals. The treatment effect, evaluated using the modified MacNab criteria, showed high rates of excellent and good outcomes in both groups, with no significant differences. Importantly, no patients experienced severe complications or required open surgery during the 6-month follow-up. Based on these findings, a new treatment combining PRF and PRP applications appears beneficial in managing pain in regenerative medicine. So, further clinical studies are necessary to support and validate our preliminary findings.
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Affiliation(s)
- Viet-Thang Le
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
- Pain Management Unit, Department of Neurosurgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Dung Tuan Hoang Bui
- Pain Management Unit, Department of Neurosurgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Phuoc Trong Do
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam.
- Pain Management Unit, Department of Neurosurgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam.
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Park S, Park JH, Sokpeou N, Jang JN, Kim YU, Choi YS, Park S. Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis. Reg Anesth Pain Med 2024:rapm-2024-105883. [PMID: 39481876 DOI: 10.1136/rapm-2024-105883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 10/13/2024] [Indexed: 11/03/2024]
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.
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Affiliation(s)
- Soyoon Park
- Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Keimyung University College of Medicine, Daegu, Korea (the Republic of)
| | - Ni Sokpeou
- Anesthesiology, Intensive Care and Emergency Medicine, Hebron Medical Center, Phnom Penh, Cambodia
| | - Jae Ni Jang
- Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
| | - Young Uk Kim
- Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
| | - Young-Soon Choi
- Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
| | - Sukhee Park
- Catholic Kwandong University College of Medicine, Gangneung, Korea (the Republic of)
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Xu B, Zhao X, Zhang L, Feng S, Li J, Xu Y. Radiofrequency vs Steroid Injections for Spinal Facet and Sacroiliac Joint Pain: A Systematic Review and Meta-Analysis. J Pain Res 2024; 17:2903-2916. [PMID: 39247173 PMCID: PMC11380878 DOI: 10.2147/jpr.s469615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 08/18/2024] [Indexed: 09/10/2024] Open
Abstract
Purpose Pain management for spinal facet joint (SFJ) and sacroiliac joint (SIJ) pain is challenging, often requiring interventions like radiofrequency ablation (RFA) or corticosteroid injections (CI). This study aims to assess and compare the effectiveness of CI and RFA in treating SFJ and SIJ pain. We combine these treatments due to their shared pathophysiology, similar therapeutic interventions, and the necessity for an integrated approach to spinal pain management. Patients and methods Literature search from PubMed, Scopus, CENTRAL and Google Scholar for published studies upto 31st December 2023, and reporting data of patients who were treated using CI of RFA for SFJ and SIJ pain. Pooled standardized mean difference (SMD) with a 95% Confidence Interval (CI) was calculated. Results Our meta-analysis incorporated thirteen studies. Overall, patients, treated with CI had a higher pain intensity score compared to patients treated with RFA (SMD=0.92; 95% CI: 0.19 to 1.65) at 3 months, and at 6 months (SMD=1.53; 95% CI: 0.66 to 2.40) after the treatment. No significant association was reported at 12 months (SMD=1.47; 95% CI: -0.03 to 2.97). Subgroup analysis based on joint types revealed increased pain intensity scores in patients who were treated with CI for SIJ (SMD=1.25; 95% CI: 0.39 to 2.11) and SFJ (SMD=1.33; 95% CI: 0.09 to 2.57) pain. A negative but not significant effect was detected in patients, treated with CI for cervical joint pain (SMD=-0.40; 95% CI: -0.90 to 0.10). Patients treated with CI exhibited higher functional disability score compared to patients treated with RFA at 3 months (SMD=1.28; 95% CI: 0.20 to 2.35) post-treatment. Conclusion This study suggests that RFA may offer superior pain relief with longer duration compared to steroid injections for spinal facet and sacroiliac joint pain. Decision regarding specific interventions should be individualized and consider patient preferences, clinical context, and potential risks.
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Affiliation(s)
- Bo Xu
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Xudong Zhao
- Physical Therapy Center, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, People's Republic of China
| | - Lei Zhang
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Shouhan Feng
- Oncology Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Jinxia Li
- Acupuncture and Rehabilitation Department, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China
| | - Ye Xu
- Rehabilitation Department, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, People's Republic of China
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4
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Naidu P, Paolucci Muran-Iwaidja O, Luta Kaurareg R, Hughes Wagadagam JT. Optimisation during transition to dialysis commencement. Med J Aust 2024; 221:18-24. [PMID: 38946647 DOI: 10.5694/mja2.52347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 07/02/2024]
Affiliation(s)
| | | | | | - Jaquelyne T Hughes Wagadagam
- Royal Darwin Hospital, Darwin, NT
- Flinders Health and Medical Research Institute, Flinders University, Darwin, NT
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Fanous SN, Saleh EG, Abd Elghafar EM, Ghobrial HZ. Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body. Br J Pain 2021; 15:270-281. [PMID: 34381612 PMCID: PMC8339942 DOI: 10.1177/2049463720942538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. OBJECTIVES To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. METHODS In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. RESULTS During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) - at baseline, 1 week, 1 month and 3 months - 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group (p <0.001, 0.014, respectively), as did the AQA (p <0.027). Steroid group was the worst. DISCUSSION RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.
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Affiliation(s)
- Sherry Nabil Fanous
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Gerges Saleh
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ekramy Mansour Abd Elghafar
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Zarif Ghobrial
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Boudier-Revéret M, Thu AC, Hsiao MY, Shyu SG, Chang MC. The Effectiveness of Pulsed Radiofrequency on Joint Pain: A Narrative Review. Pain Pract 2020; 20:412-421. [PMID: 31782970 DOI: 10.1111/papr.12863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/03/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. PURPOSE We reviewed the literature on the efficacy of PRF for controlling pain in joint disorders. METHODS We searched PubMed for papers published prior to September 7, 2019, that used PRF to treat pain due to joint disorders. The key search phrases for identifying potentially relevant articles were (PRF AND joint) OR (PRF AND arthritis) OR (PRF AND arthropathy). The following inclusion criteria were applied for the selection of articles: (1) patients' pain was caused by joint disorders; (2) PRF stimulation was applied to manage joint-origin pain; and (3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain intensity. Moreover, joints with more than 3 reported PRF studies were included in our review. RESULTS The primary literature search yielded 141 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included 34 publications in this review. Based on the positive therapeutic outcomes of previous studies, PRF stimulation seems to be an effective treatment for cervical and lumbar facet, sacroiliac, knee, and glenohumeral joint pain. PRF appears to be beneficial. For confirmation of the effectiveness of PRF on joint pain, more high-quality studies are needed. CONCLUSIONS Our review provides insights on the degree of evidence according to pain in each joint, which will help clinicians make informed decisions for using PRF stimulation in various joint pain conditions.
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Affiliation(s)
- Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Québec, Canada
| | - Aung Chan Thu
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Myanmar
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shaw-Gang Shyu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Shin SM, Kwak SG, Lee DG, Chang MC. Clinical Effectiveness of Intra-articular Pulsed Radiofrequency Compared to Intra-articular Corticosteroid Injection for Management of Atlanto-occipital Joint Pain: A Prospective Randomized Controlled Pilot Study. Spine (Phila Pa 1976) 2018; 43:741-746. [PMID: 28902105 DOI: 10.1097/brs.0000000000002414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective randomized controlled pilot study. OBJECTIVE We aimed to assess the effectiveness of pulsed radiofrequency (PRF) stimulation on the atlanto-occipital (AO) joint in patients with chronic joint pain. In addition, we compared the effects of AO intra-articular (IA) PRF and AO IA corticosteroid. SUMMARY OF BACKGROUND DATA IA injection of corticosteroids into the AO joint is widely used for the management of head and upper cervical pain, and its effectiveness has been shown in previous studies. However, little is known about the effect of PRF stimulation on the AO joint for controlling chronic head or upper cervical pain. METHODS Twenty-three consecutive patients with chronic upper cervical pain were enrolled according to the inclusion criteria and divided into one of two groups. Twelve patients received PRF stimulation with a PRF needle electrode in the IA space of the AO joint (PRF group) and 11 patients received AO IA corticosteroid injection (ICI group. Pain intensity was assessed using a numeric rating scale (NRS) before treatment and 1, 3, and 6 months afterward. Successful pain relief was defined as ≥50% reduction in NRS score 6 months post-treatment compared to pretreatment. RESULTS Mean NRS scores were significantly reduced compared to those pretreatment (P < 0.001) in both groups. Temporal changes in NRS score were not significantly different between groups (P = 0.227). Successful pain relief was achieved in 66.7% and 63.6% of patients in the PRF and ICI groups, respectively. CONCLUSION IA PRF stimulation significantly relieved AO joint pain and its effect persisted for at least 6 months after treatment. In addition, the degree of pain relief after IA PRF was not significantly different from that after ICI. We think that PRF stimulation of the AO joint could be a useful clinical treatment for patients with AO joint pain. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- So Min Shin
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Yasar D, Korgun O, Emine D. Radiofrequency and Methylprednisolone in Treatment of Lower Back Pain Caused by Facet Joint Syndrome: Comparison of the Outcomes. Asian J Neurosurg 2018; 13:283-287. [PMID: 29682022 PMCID: PMC5898093 DOI: 10.4103/1793-5482.228569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In this trial we have discussed the outcomes of radiofrequency ablation and methylprednisolone treatment in cases diagnosed with facet syndrome; and effects of treatment modality on quality of life is evaluated by visual analogue scale and Oswestry Disability Index. MATERIALS AND METHODS This prospective, study was conducted with 100 patients with diagnosis of facet joint syndrome. Patients, benefited from diagnostic block, were separated into two groups, with 50 cases in each. In Group 1, 40 mg of methylprednisolone acetate were injected into each level. In Group 2, radiofrequency needle was used to apply RF to the facet joint. RESULTS Demographic characteristics of patients were similar (P > 0.05). VAS values of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Similarly, VAS values of the patients in Group 2 were also significantly lower than the values prior to treatment (P < 0.05). When VAS scores of the patients in Group 2 at 3rd and 6th months were compared with scores of the patients in Group 1, significant differences were also observed (P < 0.01). ODI results of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Additionally ODI scores of the patients in Group 1 on 9th and 12th months are recorded as significantly lower. CONCLUSION We consider that the steroid injection should be used as the first choice of treatment before the RF methods to be used in patients with back pain, caused by facet articulation pathology, if there are no contraindications.
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Affiliation(s)
- Dagistan Yasar
- Department of Neurosurgery, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Okmen Korgun
- Department of Anesthesiology, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Dagistan Emine
- Department of Radiology, Abant Izzet Baysal University Medical School, Bolu, Turkey
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Jacobson RE, Palea O, Granville M. Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management. Cureus 2017; 9:e1635. [PMID: 29119066 PMCID: PMC5665687 DOI: 10.7759/cureus.1635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF wavelengths, the target points have remained absolutely unchanged from the original work describing RFA for lumbar pain control. Degenerative changes in the facet joint and capsule are the primary location for the majority of lumbar segmental pathology and pain. Multiple studies show that the degenerated facet joint is richly innervated as a result of the inflammatory overgrowth of the synovium. The primary provocative clinical test to justify an RFA is to perform an injection with local anesthetic into the facet joint and the posterior capsule and confirm pain relief. However, after a positive response, the radiofrequency lesion is made not to the facet joint but to the more proximal fine nerve branches that innervate the joint. The accepted target points for the recurrent sensory branch ignore the characteristic rich innervation of the pathologic lumbar facet capsule and assume that lesioning of these recurrent branches is sufficient to denervate the painful pathologic facet joint. This report describes the additional targets and technical steps for further coagulation points along the posterior capsule of the lumbar facet joint and the physiologic studies of the advantage of the bipolar radiofrequency current in this location. Bipolar RF to the facet capsule is a simple, extra step that easily creates a large thermo-coagulated lesion in this capsule region of the pathologic facet joint. Early studies demonstrate bipolar RF to the facet capsule can provide long-term pain relief when used alone for specific localized facet joint pain, to coagulate lumbar facet cysts to prevent recurrence, and to get more extensive pain control by combining it with traditional lumbar RFA, especially when RFA is repeated.
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Affiliation(s)
| | - Ovidiu Palea
- Anesthesiology and Pain Management, Provita Hospital
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Facchini G, Spinnato P, Guglielmi G, Albisinni U, Bazzocchi A. A comprehensive review of pulsed radiofrequency in the treatment of pain associated with different spinal conditions. Br J Radiol 2017; 90:20150406. [PMID: 28186832 DOI: 10.1259/bjr.20150406] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality. METHODS We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016. RESULTS We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malignancies and other minor spinal pathology, limited studies were conducted. CONCLUSION From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regard to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the absence of standardization of PRF parameters, enrolment criteria and different methods in reporting results; but, the evidence is interesting. The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF. Advances in knowledge: The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF.
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Affiliation(s)
- Giancarlo Facchini
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Paolo Spinnato
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Guglielmi
- 2 Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Ugo Albisinni
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Bazzocchi
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
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Snoddy MC, Sielatycki JA, Sivaganesan A, Engstrom SM, McGirt MJ, Devin CJ. Can facet joint fluid on MRI and dynamic instability be a predictor of improvement in back pain following lumbar fusion for degenerative spondylolisthesis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2408-15. [DOI: 10.1007/s00586-016-4525-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/27/2022]
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Maas ET, Ostelo RWJG, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW, Cochrane Back and Neck Group. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015; 2015:CD008572. [PMID: 26495910 PMCID: PMC8782593 DOI: 10.1002/14651858.cd008572.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Radiofrequency (RF) denervation, an invasive treatment for chronic low back pain (CLBP), is used most often for pain suspected to arise from facet joints, sacroiliac (SI) joints or discs. Many (uncontrolled) studies have shown substantial variation in its use between countries and continued uncertainty regarding its effectiveness. OBJECTIVES The objective of this review is to assess the effectiveness of RF denervation procedures for the treatment of patients with CLBP. The current review is an update of the review conducted in 2003. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, three other databases, two clinical trials registries and the reference lists of included studies from inception to May 2014 for randomised controlled trials (RCTs) fulfilling the inclusion criteria. We updated this search in June 2015, but we have not yet incorporated these results. SELECTION CRITERIA We included RCTs of RF denervation for patients with CLBP who had a positive response to a diagnostic block or discography. We applied no language or date restrictions. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected RCTs, extracted data and assessed risk of bias (RoB) and clinical relevance using standardised forms. We performed meta-analyses with clinically homogeneous studies and assessed the quality of evidence for each outcome using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS In total, we included 23 RCTs (N = 1309), 13 of which (56%) had low RoB. We included both men and women with a mean age of 50.6 years. We assessed the overall quality of the evidence as very low to moderate. Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall, moderate evidence suggests that facet joint RF denervation has a greater effect on pain compared with placebo over the short term (mean difference (MD) -1.47, 95% confidence interval (CI) -2.28 to -0.67). Low-quality evidence indicates that facet joint RF denervation is more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Evidence of very low to low quality shows that facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produces conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, low-quality evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur. AUTHORS' CONCLUSIONS The review authors found no high-quality evidence suggesting that RF denervation provides pain relief for patients with CLBP. Similarly, we identified no convincing evidence to show that this treatment improves function. Overall, the current evidence for RF denervation for CLBP is very low to moderate in quality; high-quality evidence is lacking. High-quality RCTs with larger patient samples are needed, as are data on long-term effects.
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Affiliation(s)
- Esther T Maas
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesAmsterdamNetherlands
| | - Raymond WJG Ostelo
- VU University AmsterdamDepartment of Health Sciences, EMGO+ Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Leena Niemisto
- Dextra Medical CenterRaumantie 1 aHelsinkiFinlandFIN‐00350
| | | | - Heikki Hurri
- Kuntoutus ORTONRehabilitation CentreTenholantie 10HelsinkiFinlandFIN‐00280
| | - Antti Malmivaara
- National Institute for Health and Welfare (THL)Centre for Health and Social Economics (CHESS)PO Box 30Mannerheimintie 166HelsinkiFinlandFI‐00271
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesAmsterdamNetherlands
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