Radiofrequency denervation of the spine and the sacroiliac joint : Asystematic literature search according to GRADE with newGerman S3 guideline

Abstract

This article summarizes the results of the German guideline on radiofrequency denervation of the facet joints and the sacroiliac joint. Evidence on the indications, test blocks and technical parameters are presented. The aim is to avoid overtreatment and undertreatment, which is also of socioeconomic importance. Asystematic evaluation of the literature was carried out according to the grading of recommendations assessment, development and evaluation (GRADE) approach. Amultidisciplinary guideline group has developed recommendations and statements. Statements and recommendations were given for 20key questions. There was an 87.5% consensus for 1 recommendation and 100% consensus for all other recommendations and statements. The guideline was approved by all scientific medical societies involved. Specific questions included the value of the medical history, examination and imaging, the need for conservative treatment prior to an intervention, the importance of test blocks (medial branch block and lateral branch block), choice of imaging for denervation, choice of trajectory, the possibility to influence the size of the lesion, stimulation, the possibility of revision, sedation and decision support for patients with anticoagulants, metal implants and pacemakers and advice on how to avoid complications. Selected patients can benefit from well-performed radiofrequency denervation. The guideline recommendations are based on very low to moderate quality of evidence.