Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain

Abstract

Background:This study aimed to demonstrate the effect of intra-articular (IA) lumbar facet joint (LFJ) pulsed radiofrequency (PRF) for the management of LFJ pain, and to compare the effect of IA LFJ PRF to IA corticosteroid injection (ICI). Pathology in the LFJ is a common source of lower back pain (LBP). It is responsible for chronic LBP in approximately 15% to 45% of patients. It has been reported that PRF stimulation can effectively reduce refractory joint pain.Methods:Sixty patients with LFJ pain were recruited and randomly assigned to 1 of 2 groups: the IA PRF group and the ICI group. There were 30 patients in each group. At pretreatment, 2 weeks, 1, 3, and 6 months after treatment, we assessed the severity of LBP using a numeric rating scale (NRS).Results:Compared with the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 2 weeks, and 1, 3, and 6 months after each treatment. Between groups, changes in the NRS scores were significantly different over time. At 2 weeks and 1 month after each procedure, the NRS score after ICI was significantly lower than that after the PRF stimulation. However, at 3 and 6 months after the procedures, the decrements of NRS scores were not significantly different between the 2 groups. Six months after treatment, about half of patients in both groups reported successful pain relief (pain relief of ≥50%).Conclusion:In the current study, both IA PRF stimulation and ICI into the LFJ significantly relieved LFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, IA PRF is a useful therapeutic option for the management of LFJ pain.

Outcome of intra‑articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis

“…To the best of our knowledge, a total of four previous studies have reported the effects of IA LFJ corticosteroid injection in controlling LFJ-origin pain (30)(31)(32)(33). In 2011, Kawu et al (30) performed IA LFJ corticosteroid injection treatment in 10 patients, 90% of whom experienced a pain reduction of >50% according to visual analogue scale (VAS) scores 6 months after treatment.…”

“…In 2013, Ribeiro et al (32) performed IA LFJ corticosteroid injection treatment in 31 patients, who exhibited a ~50% reduction in mean VAS of pre-treatment scores 3 months after treatment. In 2017, Do et al (33) performed IA LFJ corticosteroid injection treatment in 30 patients and reported that the mean NRS score was reduced from 5 at pretreatment to 3.2 at 6 months following injection. In the current study, patients were classified into 3 groups according to lumbar axial MRI results.…”

The Effectiveness of Pulsed Radiofrequency on Joint Pain: A Narrative Review

“…Thus far, 10 previous studies have reported the effect of PRF stimulation on lumbosacral facet joint pain . Of these, 4 studies were randomized trials .…”

“…Thus far, 10 previous studies have reported the effect of PRF stimulation on lumbosacral facet joint pain . Of these, 4 studies were randomized trials . In 2007, Tekin et al recruited 60 patients and performed PRF and CRF stimulations (temperature limitation: 80°C, 90 seconds, 22 gauge) on the lumbar medial branch, dividing the recruited patients into 3 equal‐sized groups (control, PRF, and CRF groups).…”

“…Six weeks after each procedure, both treatments significantly reduced the initial pain without a significant difference, but 3 and 6 months after each procedure, the PRF group showed better treatment outcomes than the IA CSI group. In 2017, Do et al compared IA PRF stimulation and intra–facet joint CSI in 60 patients with lumbosacral facet joint–origin pain. Both procedures effectively managed pain in both groups, and their effects persisted for at least 6 months.…”