title: An update of the effectiveness of therapeutic lumbar facet joint interventions.
abstract: BACKGROUND
  Therapeutic lumbar facet joint interventions are implemented to provide long-term pain relief after the facet joint has been identified as the basis for low back pain. The therapeutic lumbar facet joint interventions generally used for the treatment of low back pain of facet joint origin are intraarticular facet joint injections, lumbar facet joint nerve blocks, and radiofrequency neurotomy.
  
  
  OBJECTIVE
  To evaluate and update the effect of therapeutic lumbar facet joint interventions in managing chronic low back pain.
  
  
  METHODS
  A systematic review of therapeutic lumbar facet joint interventions for the treatment of chronic low back pain.
  
  
  METHODS
  The available literature on lumbar facet joint interventions in managing chronic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through June 2012, and manual searches of the bibliographies of known primary and review articles.
  
  
  METHODS
  The primary outcome measure was pain relief with short-term relief defined as up to 6 months and long-term relief as 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.
  
  
  RESULTS
  For this systematic review, 122 studies were identified. Of these, 11 randomized trials and 14 observational studies met inclusion criteria for methodological quality assessment. The evidence for radiofrequency neurotomy is good and fair to good for lumbar facet joint nerve blocks for short- and long-term improvement; whereas the evidence for intraarticular injections and pulsed radiofrequency neurotomy is limited.
  
  
  CONCLUSIONS
  The limitations of this systematic review include the continued paucity of evidence, specifically for intraarticular injection therapy.
  
  
  CONCLUSIONS
  In summary, there is good evidence for the use of conventional radiofrequency neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement. There is limited evidence for intraarticular facet joint injections and pulsed radiofrequency thermoneurolysis.
authors.affiliation: Mid Atlantic Spine & Pain Physicians, Newark, DE, USA. cssm01@aol.com
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Falco
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Sukdeb
authors.initials: S
authors.lastname: Datta
authors.forename: Nalini
authors.initials: N
authors.lastname: Sehgal
authors.forename: Stephanie
authors.initials: S
authors.lastname: Geffert
authors.forename: Obi
authors.initials: O
authors.lastname: Onyewu
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Sareta
authors.initials: S
authors.lastname: Coubarous
authors.forename: Mariam
authors.initials: M
authors.lastname: Hameed
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Ward
authors.forename: Manohar
authors.initials: M
authors.lastname: Sharma
authors.forename: Haroon
authors.initials: H
authors.lastname: Hameed
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.forename: Mark V
authors.initials: MV
authors.lastname: Boswell
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use; D017115:Catheter Ablation; D059350:Chronic Pain / Q000628:therapy*; D006801:Humans; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000628:therapy*; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*; D021801:Zygapophyseal Joint
chemical_list: D000779:Anesthetics, Local