Comparative efficacy of radiofrequency denervation in chronic low back pain: A systematic review and network meta-analysis

Efficacy of Epidural Pulsed Radiofrequency Treatment in Persistent Spinal Pain Syndrome: A Prospective Clinical Study

Background: Persistent spinal pain syndrome type-2 (PSPS-II) is a chronic condition that is characterized by severe pain and results in disability and a significant reduction in quality of life. Despite the wide range of interventional pain treatments that are applied, depending on the complexity of the etiology, epidural pulsed radiofrequency (EPRF) application has emerged as an approach that has gained popularity in recent years. Objective: The objective of this study is to examine the efficacy of EPRF in patients diagnosed with PSPS-II. Methodology: In this prospectively designed study, patients with PSPS-II who had not responded to conservative treatments and epidural steroid injections were subjected to fluoroscopy-guided EPRF. Patients were evaluated with the Numeric Rating Scale (NRS) for pain severity and the Douleur Neuropathique-4 (DN-4) questionnaire for presence of neuropathic pain before the procedure and at one and three months after. Although the change in NRS score was established as the primary outcome measure, the change in the number of patients with neuropathic pain according to the DN-4 was determined as the secondary outcome measure. Result: In the final analysis, data from 42 patients were evaluated. The analysis of the time-dependent change in NRS revealed a statistically significant reduction in the scores for the first and third months, in comparison with the initial measurement. A significant decrease was observed in the number of patients diagnosed with neuropathic pain according to the DN-4 questionnaire in the first month, in comparison with the baseline. However, no significant change was noted in the third month. Conclusion: The utilization of EPRF for the treatment of chronic radicular pain in the setting of PSPS-II appears to be effective in the short term. Further studies are required to ascertain its long-term effects. Trial Registration: ClinicalTrials.gov identifier: NCT06239857.

Comparing the Hip and Lumbar Joint Range of Motion in Patients With Lower Lumbar Disc Herniation and Healthy Subjects

BACKGROUND

One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH).

METHOD

A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05.

RESULTS

The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510).

CONCLUSION

Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.

[Influence of local anesthesia methods on the results of radiofrequency facet denervation]

BACKGROUND

One of the elements of lower back pain is facet syndrome. Radiofrequency facet denervation is an effective minimally invasive method for this pain. There is no consensus regarding local anesthesia method for this manipulation. Researchers believe that introduction of anesthetic before denervation leads to needle displacement and deterioration of effect.

OBJECTIVE

To evaluate the influence of local anesthesia methods on the results of radiofrequency facet denervation.

MATERIAL AND METHODS

A single-center retrospective study included adults with typical pain syndrome who underwent radiofrequency facet denervation L3-S1 between 2022 and 2024. Patients were divided into three groups depending on anesthesia. In the control group («K»), patients did not receive injection of anesthetic in ablation area. In the main groups, patients received injection of anesthetic before (group «A») and after (group «B») denervation. Intensity of pain syndrome during denervation and 24 hours later was assessed using the VAS scale. After 6 months, effectiveness of the procedure was assessed using the SF-36 and ODI.

RESULTS AND DISCUSSION

The study involved 351 people. Of these, 131 ones were excluded for various reasons. Patients were divided into groups: control - 67, group «A» - 87, group «B» - 66 people. Six months after denervation, all patients demonstrate significant reduction in pain syndrome and QoL improvement without significant between-group differences. Pain syndrome during denervation and on the first day after surgery was significantly lower in the group «A».

CONCLUSION

Injection of anesthetic before denervation does not affect the result, while this approach significantly reduces pain syndrome during intervention.

Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials

BACKGROUND

Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control.

MATERIALS AND METHODS

A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months).

RESULTS

Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection.

CONCLUSIONS

RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

STUDY DESIGN

Retrospective study of prospective collected data.

OBJECTIVE

To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis.

SUMMARY OF BACKGROUND DATA

IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed.

METHODS

We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis.

RESULTS

A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery.

CONCLUSION

Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.

3. Pain originating from the lumbar facet joints

INTRODUCTION

Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age.

METHODS

The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.

RESULTS

There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.

CONCLUSIONS

Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

Radiofrequency Ablation for the Management of Pain of Spinal Origin in Orthopedics

Radiofrequency (RF) is a minimally invasive procedure for interrupting or modifying nociceptive pathways to manage musculoskeletal neuropathic and nociplastic pain. RF has been used to manage cervical and lumbar facet joint syndromes. The benefits of RF are the following: it is safer than surgery; it doesn´t need general anesthesia, by that means diminishing the complications; it causes pain alleviation for a minimum of 3-4 months; it can be repeated if needed; it improves joint function; and it minimizes the necessity for oral pain treatment. RF must not be used in pregnant women; unstable joints, uncontrolled diabetes mellitus; and presence of an implanted defibrillator. Even though complications from RF are rare, possible adverse events are infection, hemorrhage, numbness or dysesthesia, greater pain in the procedure area, and differentiation impact. Even though there is a peril of injuring non-targeted neural tissue and other tissues, this can be lessened by carrying out the procedure with the help of fluoroscopy, ultrasonography or computed tomography. RF seems to be a helpful procedure for relieving chronic pain syndromes; despite this, definite proof of the procedure's effectiveness is still needed. RF is an encouraging procedure for treating chronic spinal pain, especially when other procedures are pointless or not feasible.