Lumbar facet joint steroid injection versus Radiofrequency denervation for chronic low back pain: systematic review
DOI:
https://doi.org/10.65759/ppycxn58Keywords:
chronic low back pain, lumbar facet joint, corticosteroid injection, radiofrequency denervation, facetogenic pain, systematic reviewAbstract
Study aim: The study aimed to compare the clinical efficacy and safety of radiofrequency denervation versus corticosteroid injection for chronic low back pain originating from the lumbar facet joints. Methods: According to PRISMA 2020 guidelines we searched PubMed, Web of Science, Scopus, CENTRAL, and Embase from inception to 2025. Eligible studies included adults with chronic lumbar facet mediated pain treated with RFD or corticosteroid-based facet interventions. Pain reduction was the primary outcome; disability, treatment success, and adverse events were secondary outcomes. Results: We include 16 primary studies involving more than 1,900 participants, with follow-up from 3 to 24 months. Both interventions reduced pain, and corticosteroid injections produced faster short-term relief, whereas radiofrequency techniques showed more durable pain control and better long-term functional improvement in several comparative studies. Sham-controlled trials and the MINT trials did not show clinically important advance of routine radiofrequency over control strategies, which indicate that patient selection, diagnostic rigor, and procedural technique impact outcomes. Both treatments were safe, with minor adverse events reported. Conclusion: Facet steroid injection is useful for early symptom control, whereas RFD provide longer-lasting benefit in carefully selected patients with confirmed facetogenic pain.
References
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. The Lancet 2018;391:2356–67. https://doi.org/10.1016/S0140-6736(18)30480-X.
[2] Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 1995;54:100–6. https://doi.org/10.1136/ard.54.2.100.
[3] Cohen SP, Raja SN. Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain. Anesthesiology 2007;106:591–614. https://doi.org/10.1097/00000542-200703000-00024.
[4] Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020;45:424–67. https://doi.org/10.1136/rapm-2019-101243.
[5] Lakemeier S, Lind M, Schultz W, Fuchs-Winkelmann S, Timmesfeld N, Foelsch C, et al. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint RADIOFREQUENCY DENERVATION in the treatment of low back pain: A randomized, controlled, double-blind trial. Anesth Analg 2013;117:228–35. https://doi.org/10.1213/ANE.0b013e3182910c4d.
[6] Maas ET, Ostelo RW, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, et al. RADIOFREQUENCY DENERVATION for chronic low back pain. Cochrane Database of Systematic Reviews 2015;2015. https://doi.org/10.1002/14651858.CD008572.pub2.
[7] Do KH, Ahn SH, Cho YW, Chang MC. Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain: A randomized controlled trial. Medicine (United States) 2017;96. https://doi.org/10.1097/MD.0000000000006524.
[8] McCormick ZL, Conger A, Kendall R, Wagner G, Henrie AM, Littell M, et al. A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes. Pain Medicine 2023;24:1318–31. https://doi.org/10.1093/pm/pnad107.
[9] Juch JNS, Maas ET, Ostelo RWJG, George Groeneweg J, Kallewaard JW, Koes BW, et al. Effect of RADIOFREQUENCY DENERVATION on pain intensity among patients with chronic lowback pain the mint randomized clinical trials. JAMA - Journal of the American Medical Association 2017;318:68–81. https://doi.org/10.1001/jama.2017.7918.
[10] Kwak D, Kwak S, Lee A, Chang M. Outcome of intra articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis. Exp Ther Med 2019. https://doi.org/10.3892/etm.2019.8031.
[11] Yilmaz A, Kucukbingoz C. Comparative Outcomes and Safety of Radiofrequency Ablation and Cryoablation for Lumbar Facet Joint Degeneration: A Single-Center Retrospective Cohort Study with 24-Month Follow-Up. J Clin Med 2025;14. https://doi.org/10.3390/jcm14207408.
[12] Civelek E, Cansever T, Kabatas S, Kircelli AK, Yilmaz C, Musluman M, et al. Comparison of effectiveness of facet joint injection and RADIOFREQUENCY DENERVATION in chronic low back pain. Turk Neurosurg 2012;22:200–6. https://doi.org/10.5137/1019-5149.JTN.5207-11.1.
[13] Toubar A, Dawood O. Facet Joint Injection versus Radiofrequency Facet Neurotomy for Treatment of Lumbar Facet Joint Arthropathy. Egyptian Spine Journal 2018;28:25–31. https://doi.org/10.21608/esj.2019.4725.1057.
[14] Zhou Q, Zhou F, Wang L, Liu K. An investigation on the effect of improved X-rays-guided radiofrequency thermocoagulation denervation on lumbar facet joint syndrome. Clin Neurol Neurosurg 2016;148:115–20. https://doi.org/10.1016/j.clineuro.2016.07.018.
[15] Van Tilburg CWJ, Stronks DL, Groeneweg JG, Huygen FJPM, Van Tilburg C W J. Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain n.d. https://doi.org/10.1302/0301-620X.98B11.
[16] Van Wijk RMAW, Jos †, Geurts WM, Wynne HJ, Hammink E, Buskens E, et al. RADIOFREQUENCY DENERVATION of Lumbar Facet Joints in the Treatment of Chronic Low Back Pain A Randomized, Double-Blind, Sham Lesion-Controlled Trial. n.d.
[17] Tekin I, Mirzai H, Ok G, Erbuyun K, Vatansever D. A Comparison of Conventional and Pulsed RADIOFREQUENCY DENERVATION in the Treatment of Chronic Facet Joint Pain. 2007.
[18] Shealy CN. Percutaneous RADIOFREQUENCY DENERVATION of spinal facets Treatment for chronic back pain and sciatica. n.d.
[19] Wolter T, Deininger M, Hubbe U, Mohadjer M, Knoeller S. Cryoneurolysis for zygapophyseal joint pain: A retrospective analysis of 117 interventions. Acta Neurochir (Wien) 2011;153:1011–9. https://doi.org/10.1007/s00701-011-0966-9.
[20] Li SJ, Zhang SL, Feng D. A comparison of pulsed radiofrequency and RADIOFREQUENCY DENERVATION for lumbar facet joint pain. J Orthop Surg Res 2023;18. https://doi.org/10.1186/s13018-023-03814-5.
[21] Çetin A, Yektaş A. Evaluation of the Short- and Long-Term Effectiveness of Pulsed Radiofrequency and Conventional Radiofrequency Performed for Medial Branch Block in Patients with Lumbar Facet Joint Pain. Pain Res Manag 2018;2018. https://doi.org/10.1155/2018/7492753.
