Efficacy of radiofrequency lesioning for chronic spinal pain: A systematic review

Abstract

Introduction: Facet joint pain, discogenic pain, sacroiliac joint (SIJ) pain, and radicular pain are chronic spinal pain conditions, where radiofrequency (RF) lesioning has been used so far with variable results. It is always desired to choose a therapeutic option based on its current evidence. The present systematic review has focused on the efficacy of RF lesioning for chronic spinal pain conditions. Methods: A literature search was done in PubMed from the year 1966 onward. The basic idea of the literature search was to find out studies focusing on RF lesioning for chronic spinal pain. The randomized controlled trials and observational studies focusing on RF lesioning for chronic spinal pain of more than 3 months duration have been included in this review. Results: A total of 286 studies have been identified after literature search and assessed for inclusion in this review. Forty-two of these studies meeting the inclusion criteria have been included for the formulation of evidence; 26 of these studies were of high quality, 14 were of moderate quality, and 2 were of low quality as per Cochrane review criteria score. The level of evidence for RF lesioning of conditions giving rise to nonradicular pain is Level I for continuous RF lesioning of lumbar facet medial branch, for both short- and long-term effectiveness; level II evidence for continuous RF lesioning of cervical facet medial branch, continuous RF or cooled RF lesioning of SIJ and bipolar cooled RF in intradiscal biacuplasty for discogenic pain, for both short- and long-term effectiveness; level III evidence for continuous RF lesioning of thoracic facet medial branch. For radicular pain management, there is Level II evidence for dorsal root ganglion (DRG) pulsed RF lesioning, for both short- and long-term effectiveness. Conclusion: The evidence for RF lesioning of chronic spinal pain is summarized as follows: Nonradicular pain. Cervical facet joint pain: Level II evidence for continuous RF lesioning of cervical facet medial branch. Thoracic facet joint pain: Level III evidence for continuous RF lesioning of thoracic facet medial branch. Lumbar facet joint pain: Level I evidence for continuous RF lesioning of lumbar facet medial branch. Sacro-iliac joint pain: Level II for continuous RF or cooled RF lesioning of SIJ. Discogenic pain: Level II evidence for bipolar cooled RF in intradiscal biacuplasty for discogenic pain. Radicular Pain: Level II evidence for DRG pulsed RF lesioning for the management of radicular pain.