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Radiofrequency Denervation for Facet Joint Low Back Pain: A Systematic Review

Poetscher, Arthur Werner, MD, Msc; Gentil, Andre Felix, MD, PhD; Lenza, Mario, MD, PhD; Ferretti, Mario, MD, PhD

doi: 10.1097/BRS.0000000000000337
Literature Review

Study Design. A systematic review and meta-analysis of randomized controlled trials.

Objective. To assess treatment effects (benefits and harms) of radiofrequency denervation for patients with facet joint–related chronic low back pain.

Summary of Background Data. There is no consensus regarding the treatment efficacy of facet joint radiofrequency denervation (FJRD) and how it compares with nerve blockades and joint infiltration with anesthetics and/or corticosteroids.

Methods. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS for randomized controlled trials that compared FJRD with blockades, infiltrations, or placebo. Primary outcomes were pain, functional status, and quality of life. Secondary outcomes were cost-effectiveness and complications.

Results. Fifteen studies were selected and 9 were eligible. Overall quality of evidence was rated low to moderate. The evidence favored FJRD regarding pain control. There was no sufficient evidence for cost-effectiveness and complications.

Conclusion. The available evidence reviewed in this study should be interpreted with caution. The data indicate that FJRD is more effective than placebo in pain control and functional improvement and is also possibly more effective than steroid injections in pain control. Complications and adverse effects were not sufficiently reported to allow comparisons, and there was no evidence for cost-effectiveness. High-quality randomized controlled trials addressing pain, function, quality of life, complications, and cost-effectiveness are urgently needed.

Level of Evidence: 1

This is a systematic review with meta-analysis that assessed the effectiveness of radio frequency denervation for facet joint low back pain. Nine trials were included in the review and the results suggested that facet joint radio frequency denervation is more effective than placebo in pain control and functional improvement and is also possibly more effective than steroid injections in pain control.

From the Hospital Israelita Albert Einstein, Sao Paulo, Brazil.

Address correspondence and reprint requests to Arthur Werner Poetscher, Msc, MD, Avenida Albert Einstein, 627/701, Bloco A1, Office 308, Jardim Leonor, CEP: 05652-900, São Paulo, SP, Brazil; E-mail:

Acknowledgment date: December 12, 2013. Revision date: March 13, 2014. Acceptance date: March 13, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: Local Spine Board membership.

© 2014 by Lippincott Williams & Wilkins