Efficacy of radiofrequency procedures for the treatment of spinal pain: A systematic review of randomized clinical trials

Background and Objectives: The use of radiofrequency (RF) procedures in the peripheral nervous system to treat chronic spinal pain has been the subjec t of controversy. Publications concerned only uncontrolled studies, and irr eversible nervous tissue damage was believed to be responsible for the effe ct, if any. In recent years, randomized, controlled studies have appeared, which have attested to an increasing use of these techniques. This is a sys tematic review of randomized controlled trials on RF procedures for spinal pain. Methods: We performed a standardized literature search for randomized, cont rolled trials. Three adjudicators independently registered trial methodolog y and outcome using validated and subject-related instruments. Interadjudic ator disagreement was resolved by discussion. It was found necessary to dev ise additional parameters of study assessment. Results: Six trials met the inclusion criteria. This small number, along wi th clinical and technical heterogeneity precluded statistical analysis. All studies, whether high or low quality, reported positive outcomes. Conclusions: We conclude that there is moderate evidence that RF lumbar fac et denervation is more effective for chronic low back pain than placebo. Li mited evidence exists for efficacy of RF neurotomy in chronic cervical zyga pophyseal joint pain after flexion-extension injury. There is limited evide nce that RF heating of the dorsal root ganglion is more effective than plac ebo in chronic cervicobrachialgia. We recommend the systematic application of our additional parameter assessments for future evaluations of RP studie s. These additional parameters should also be used in the preparation of fu ture trial protocols of RF procedures for the treatment of chronic pain.