A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain.
BACKGROUND
Lumbar zygapophysial joints are currently believed to be a cause of axial low back pain. Once this diagnosis is made, decisions about when to institute a particular intervention and which treatment to offer is regionally and specialty dependent.


OBJECTIVE
To perform a critical review of prior published studies assessing the use of interventional treatment options for the treatment of lumbar zygapophysial joint syndrome.


METHODS
Evidence-based medicine analysis of current literature.


METHODS
A database search of Medline (PubMed, Ovid and MDConsult), Embase and the Cochrane database was conducted. The keywords used were low back pain, lumbar zygapophysial joint, lumbar facet joint, radiofrequency denervation, medial branch block, and intraarticular injection. After identifying all relevant literature, each article was reviewed. Data from the following categories were compiled: inclusion criteria, randomization of subjects, total number of subjects involved at enrollment and at final analysis. statistical analysis used, intervention performed, outcome measures, follow-up intervals and results. Guidelines described by the Agency for Health Care Policy and Research were then applied to these data.


RESULTS
This review determined that the evidence for the treatment of lumbar zygapophysial joint syndrome with intraarticular injections should be rated as level III (moderate) to IV (limited) evidence, whereas that for radiofrequency denervation is at a level III.


CONCLUSIONS
Current studies fail to give more than sparse evidence to support the use of interventional techniques in the treatment of lumbar zygapophysial joint-mediated low back pain. This review emphasizes the need for larger, prospective, randomized controlled trials with uniform inclusion and exclusion criteria, standardized treatment, uniform outcome measures and an adequate duration of follow-up period so that definitive recommendations for the treatment of lumbar zygapophysial joint-mediated pain can be made.
Penn Spine Center Research Group, Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Ground Floor--White Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. slipman@mail.med.penn.edu
Curtis W
CW
Slipman
Atul L
AL
Bhat
Russell V
RV
Gilchrist
Zacharia
Z
Issac
Larry
L
Chou
David A
DA
Lenrow
D003714:Denervation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000078702:Radiofrequency Therapy; D011859:Radiography; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000294:innervation* / Q000503:physiopathology* / Q000528:radiation effects