Low back pain (LBP) is one of the most common musculoskeletal complaints encountered in clinical practice. It is considered one of the leading causes of disability in the developed world and an unparalleled cost generator for society and, unquestionably, for healthcare providers1.
Despite variable epidemiological evidence, some studies implicate the lumbar facets as the primary pain generator in 10% to 15% of young adult patients with chronic LBP. In older populations, this prevalence increases to 40% to 45%2,3.
The treatment for lumbosacral facet pain usually follows a multidisciplinary approach. Non-invasive procedures include management with pain medication and physiotherapy. More invasive options are lumbar facet blocks and steroid injections; that offer rather limited pain relief3. Lumbosacral radiofrequency ablation (RFA) is a commonly used intervention that involves selective destruction of medial branch nerves by thermal lesioning to disrupt nociception from painful lumbar facet joints.
EFFECTIVENESS OF RFA
Although the clinical efficacy of lumbar facet and SIJ RF denervation has been a matter of debate in recent years, (See publication: Interpreting the MINT RCT by Provenzano et al), there is a conclusive body of evidence that upholds the safe utilization of the procedure in the clinical practice.
Indeed, the safety and quality-of-life improvements after lumbosacral RFA were established in two large retrospective real-world studies. A first study, including almost 50K patients, quantified the rates of recurring RFA procedures and opioid use after lumbosacral RFA, demonstrating that repeat RFA is performed in one-third of the patients over 3 years. Moreover, RFA was associated with reduced opioid prescription rates4.
In complement, a second real-world study including 1661 patients who underwent lumbosacral RFA (out of 4653 analyzed cases) showed not only a marked reduction in healthcare services utilization after 12 months following RFA but also fewer physician visitations, with some patients eliminating opioid use5. Additional supportive evidence can be found in the review study of Leggett L.E6, which includes the collective results of five independent clinical studies that show the efficacy of conventional RFA in reducing lumbar facet joint pain.
This cumulative evidence provides real-world insight into the utilization of lumbosacral RFA as well as the effectiveness and safety of the procedure, hence justifying the clinical use of this modality for the most ubiquitous pain condition: chronic low back pain.