PMID- 28576500 OWN - NLM STAT- MEDLINE DCOM- 20180601 LR - 20181202 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 17 IP - 11 DP - 2017 Nov TI - The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. PG - 1770-1780 LID - S1529-9430(17)30197-3 [pii] LID - 10.1016/j.spinee.2017.05.006 [doi] AB - BACKGROUND CONTEXT: Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. PURPOSE: We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. STUDY DESIGN/SETTING: A meta-analysis of randomized controlled trials was carried out. PATIENT SAMPLE: Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. OUTCOME MEASURES: Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. METHOD: We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. RESULTS: We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments. CONCLUSIONS: Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Lee, Chang-Hyun AU - Lee CH AD - Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwaro, Ilsan Seo-gu, Goyang, Gyeonggi, 10380, Republic of Korea. FAU - Chung, Chun Kee AU - Chung CK AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Brain and Cognitive Sciences, 203-105B, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea. Electronic address: chungc@snu.ac.kr. FAU - Kim, Chi Heon AU - Kim CH AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review DEP - 20170530 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adult MH - Aged MH - Denervation/adverse effects/*methods MH - Female MH - Humans MH - Low Back Pain/*surgery MH - Lumbar Vertebrae/innervation/surgery MH - Male MH - Middle Aged MH - Postoperative Complications/*epidemiology/etiology MH - Randomized Controlled Trials as Topic MH - Zygapophyseal Joint/innervation/surgery OTO - NOTNLM OT - Back pain OT - Denervation OT - Facet joint OT - Medial branch OT - Radiofrequency OT - Rhizotomy OT - Zygapophyseal joint EDAT- 2017/06/04 06:00 MHDA- 2018/06/02 06:00 CRDT- 2017/06/04 06:00 PHST- 2016/12/07 00:00 [received] PHST- 2017/04/08 00:00 [revised] PHST- 2017/05/02 00:00 [accepted] PHST- 2017/06/04 06:00 [pubmed] PHST- 2018/06/02 06:00 [medline] PHST- 2017/06/04 06:00 [entrez] AID - S1529-9430(17)30197-3 [pii] AID - 10.1016/j.spinee.2017.05.006 [doi] PST - ppublish SO - Spine J. 2017 Nov;17(11):1770-1780. doi: 10.1016/j.spinee.2017.05.006. Epub 2017 May 30.