Abstract
Introduction Zygapophysial joint pain can be treated by RF neurotomy of the medial branch of the dorsal primary rami of the adjacent spinal nerves. The provision of radiofrequency (RF) neurotomy for spinal joint pain has been highlighted as an emerging trend in Australia, Europe and North America. However, there is controversy regarding the efficacy of this procedure. RF neurotomy for spinal pain has been investigated in several experimental and observational studies but these have reported conflicting results.
The purpose of this project was to provide a systematic review of the literature on RF neurotomy for the treatment of spinal pain of zygapophysial joint origin.
Method Electronic database searches, screening of reference lists, hand searching and consultation with experts in the field was undertaken to identify relevant studies. Publications were selected based on predetermined inclusion criteria and the methodological quality of each was rated. Qualitative analysis was performed using the Cochrane Collaboration Back Review Group (CCBRG) levels of evidence (RCTs only) and those used by the National Health and Medical Research Council (NHMRC) (RCTs, observational studies, systematic reviews and guidelines)
Results The search strategy identified 382 potential publications. Of these, 80 studies were selected for review, including 7 RCTs, 52 observational studies, 11 systematic reviews and 10 guidelines. There is conflicting (CCBRG) evidence regarding the efficacy of RF neurotomy for lumbar zygapophysial joint pain. The conclusions of systematic reviews and observational studies are conflicting regarding the efficacy of this procedure for the lumbar spine. In contrast, there is limited (CCBRG) evidence that RF neurotomy is efficacious for neck pain of zygapophysial joint origin in the short term. However, this was reported in one very small RCT which reported only one composite outcome.
Discussion This systematic review found that there is no consistent evidence from either multiple (large) RCTs or systematic reviews that RF neurotomy is efficacious in the treatment of spinal joint pain RCTs need to be conducted with larger sample sizes, (patient) relevant outcomes and adequate assessment of side-effects, which can be serious.
The abstracts were prepared by Assoc Prof Bruce McPhee. Correspondence should be addressed to him at the Division of Orthopaedics, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4029, Australia.
