Radiofrequency Ablation and Facet Joint Injections are Effective in Treating Lumbar Facet Joints for Pain and Functional Outcomes: A Systematic Review and Meta Analysis of Randomized Controlled Trials

Background and/or Objectives: This systematic review with meta-analysis aimed to evaluate the effectiveness of RFA versus Facet joint injections (FJI) and intra-articular injections (IAI) in the treatment of lumbar facet joint pain.

Design: Systematic review with meta-analysis

Setting : Pain Medicine Outpatient offices

Participants : 90 articles remained after full text appraisal was completed with 21 articles included in the Meta-Analysis. 1,684 participants were evaluated in this study.

Interventions: None applicable

Main Outcome Measures: This study followed the PRISMA 2020 guidelines. Six databases were searched. Outcomes of interest included a decrease in Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) for functional outcomes.

Results: 3,183 articles were found after the initial query with 21 being included in our meta-analysis.
19 randomized controlled trials (RCT) were included to measure pain using VAS. Subgroup analysis of homogeneity demonstrated no statistically significant difference between the groups (p = 0.51). The RFA group had a large improvement in hypertrophy compared to baseline (p = 0.00, Cohen’s D = -3.01 [-4.56, -1.46], I2 = 99%) , equivalent to the FJI/IAI group (p = 0.00, Cohen’s D = -2.37 [-3.47, -1.27], I2 = 97.3%).
14 RCTs comprising n = 712 healthy subjects were included to measure functional outcome using ODI. Subgroup analysis of homogeneity demonstrated no statistically significant difference between the groups (p = 0.80). The RFA group had a large improvement in hypertrophy compared to baseline (p = 0.00, Cohen’s D = -1.87 [-2.91, -0.82], I2 = 97.6%), equivalent to the FJI/IAI group (p = 0.00, Cohen’s D = -1.70 [-2.54, -0.85], I2 = 94.2%).

Conclusions: RFA and FJI/IAI showed an improvement in pain scores when administered. Results from this study show statistically significant improvement in both pain and ODI in both groups at 6 months compared to baseline. There were no significant differences in outcomes between the 2 groups at 6 months' follow up.