Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough?,European Spine Journal

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Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough?
European Spine Journal ( IF 2.6 ) Pub Date : 2023-12-23 , DOI: 10.1007/s00586-023-08078-5
Ruihuan Du ₁ , Jing Gao ₂ , Bo Wang ₁ , Jing Zhang ₁ , Meng Meng ₁ , Jingzuo Wang ₁ , Wentao Qu ₁ , Zhonghai Li _{1,

3}

Affiliation

Objective

Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy.

Methods

We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software.

Results

A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1 year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = −0.87, 95% confidence interval (CI) [−2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = −0.13, 95%CI [−0.18, −0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0 .0001).

Conclusion

The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness.

中文翻译：

经皮射频消融术和内窥镜神经切断术治疗腰椎小关节综合征：它们足够好吗？

客观的

腰椎小关节（LFJ）综合征是腰痛（LBP）的常见原因之一。对于经皮射频和内窥镜射频有不同的看法。本次系统评价和荟萃分析的目的是探讨射频消融术治疗源自LFJ的LBP的疗效，并比较经皮射频消融术与内镜下神经切断术的治疗效果。

方法

我们纳入了随机对照试验，比较经皮射频消融和保守治疗（假手术、小关节注射、物理治疗、运动或口服药物）的效率，或比较经皮射频消融和内镜神经切断术治疗 LFJ 综合征的效率。我们在 PubMed 和 Web of Science 中检索了从建站到 2023 年 3 月 27 日的数据。使用 RevMan 5.4 软件进行荟萃分析。

结果

总共纳入了 11 项随机对照试验。其中，9项研究用于评估经皮射频消融术的效率，2项研究用于评估内镜神经切断术的效率。通过比较经皮射频消融和保守治疗，报告 1 年结果的两项研究的汇总数据并未显示小关节去神经术的益处（标准化平均差 (SMD) = -0.87，95% 置信区间 (CI) [-2.10， 0.37]， P = 0.17）。 1个月随访时，经皮射频消融术与内镜神经切断术之间无显着差异（平均差（MD）= -0.13，95% CI [-0.18，-0.44]， P = 0.41）。 12 个月随访时，内镜神经切断术的疼痛缓解明显优于经皮射频消融组（MD = 1.98，95% CI [1.60，2.36]， P < 0 .0001）。