title: The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data.
abstract: OBJECTIVE
  To determine the effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy (CMBTRFN) for treating chronic neck pain of zygapophysial joint origin.
  
  
  METHODS
  Systematic review of the literature with comprehensive analysis of the published data.
  
  
  METHODS
  Four reviewers formally trained in evidence-based medicine searched the literature on CMBTRFN. Each assessed the methodologies of studies found and appraised the quality of evidence presented.
  
  
  METHODS
  The primary outcomes assessed were 100% relief of pain 6 and 12 months after treatment. Other outcomes were noted if reported. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
  
  
  RESULTS
  The searches yielded eight primary publications on the effectiveness of the procedure. The evidence shows a majority of patients were pain free at 6 months and over a third were pain free at 1 year. The number needed to treat for complete pain relief at 6 months is 2. The evidence of effectiveness is of high quality according to the GRADE system. Twelve papers were found reporting unwanted effects, most of which are minor and temporary. No serious complications have ever been reported from procedures performed according to the published guidelines. The evidence of risks is of low quality according to the GRADE system.
  
  
  CONCLUSIONS
  If performed as described in the International Spine Intervention Society Guidelines, fluoroscopically-guided CMBTRFN is effective for abolishing zygapophysial joint pain and carries only minor risks.
authors.affiliation: *Affordable Pain Management, Chicago, Illinois, USA engel.andrew@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Engel
authors.affiliation: Los Angeles Minimally Invasive Spine Institute, Los Angeles, California, USA.
authors.forename: George
authors.initials: G
authors.lastname: Rappard
authors.affiliation: Mayo Private Hospital, Manning Pain Management, Taree, New South Wales, Australia.
authors.forename: Wade
authors.initials: W
authors.lastname: King
authors.affiliation: Department of Orthopaedics, Stanford University, Redwood City, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D019771:Axotomy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D019547:Neck Pain / Q000601:surgery*; D064887:Observational Studies as Topic; D059408:Pain Management / Q000379:methods; D016896:Treatment Outcome; D021801:Zygapophyseal Joint
keywords: Branch; Cervical; Facet; Medial; Neurotomy; Radiofrequency; Zygapophysial