Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy.
METHODS
A prospective double-blind randomized controlled trial was performed.


OBJECTIVE
To assess the efficacy of percutaneous radiofrequency articular facet denervation for low back pain.


BACKGROUND
Uncontrolled observational studies in patients with low back pain have reported some benefits from the use of facet joint radiofrequency denervation. Because the efficacy of percutaneous radiofrequency had not been clearly shown in previous studies, a randomized controlled trial was conducted to assess the efficacy of the technique for improving functional disabilities and reduce pain.


METHODS
For this study, 70 patients with low back pain lasting of more than 3 months duration and a good response after intraarticular facet injections under fluoroscopy were assigned randomly to receive percutaneous radiofrequency articular facet denervation under fluoroscopic guidance or the same procedure without effective denervation (sham therapy). The primary outcomes were functional disabilities, as assessed by the Oswestry and Roland-Morris scales, and pain indicated on a visual analog scale. Secondary outcomes included spinal mobility and strength.


RESULTS
At 4 weeks, the Roland-Morris score had improved by a mean of 8.4% in the neurotomy group and 2.2% in the placebo group, showing a treatment effect of 6.2% (P = 0.05). At 4 weeks, no significant treatment effect was reflected in the Oswestry score (0.6% change) or the visual analog pain score (4.2% change). At 12 weeks, neither functional disability, as assessed by the Roland-Morris scale (2.6% change) and Oswestry scale (1.9% change), nor the pain level, as assessed by the visual analog scale (-7.6% change), showed any treatment effect.


CONCLUSIONS
Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.
Leclaire
R
R
Center for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. laf.lec@sympatico.ca
Fortin
L
L
Lambert
R
R
Bergeron
Y M
YM
Rossignol
M
M
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D003714:Denervation / Q000379:methods*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010919:Placebos; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000294:innervation*
D010919:Placebos