Radiofrequency Neurotomy for Chronic Lumbar Facet Pain-Interpreting the Evidence

Abstract

Spine published the results of a randomized clinical trial entitled "Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy." 1 Certain medical assessment groups have interpreted this study as evidence that all radiofrequency neurotomy for the treatment of chronic low back pain is ineffective. While we consider that the Leclaire et al. study was conducted in a sound, scientific manner, we want to be certain that the results have not been improperly interpreted and extrapolated by certain medical assessment groups.By this open letter to the authors, we would request an explanation on precisely what medical assessment groups should interpret from the results of the study. How did the study methodology differ from other randomized controlled trials that have endorsed radiofrequency neurotomy for the treatment of chronic lumbar facet pain?We would also appreciate the authors' comments as to how the methodology performed in their study differed from other approaches for both the selection of patients and for the technical performance of the radiofrequency neurotomy procedure?

Simultaneous multidisciplinary care pathway for back pain: a new approach for a first-level comprehensive evaluation and treatment to guarantee adequate pain relief and recovery

“…In fact, considering all different interventions alone, without a multidisciplinary approach, rehabilitation programs can produce the same effect as radiofrequency (26), that is, the opposite of what is widely accepted by current evidence (27,28). Independently of the several bias and of the not accurate selection of the patients ( 29), Juch et al (26) show that in order to treat the disorder "LBP" we cannot simply compare a single procedure with another one, but there is a specific need for a simultaneous pathway care in which physicians, physiotherapists, and psychologists can act together according to specific needs of the patients in a specific moment.…”

August 2012

“…They (100,278) included only one study by Nath et al (276). In this criticism, Chou et al (3,(8)(9)(10)(11)13) ignore the methodological flaws which were not only described by authors of ASIPP critiques, but multiple others, including the authors of the manuscript who admitted that their methodology was flawed (279)(280)(281)(282). Essentially, in reference to radiofrequency neurotomy, it appears to be clear that Chou et al (13) do not understand clinical significance, as they do not think that there is any value for properly positioning a radiofrequency cannula.…”

“…Interestingly enough, in response to Gauci's (279) request, Leclaire et al (280) acknowledged multiple deficiencies. They described that their study used an invalidated and dated approach (278)(279)(280)(281)(282)(283)(284)(285), and acknowledged the value of controlled local anesthetic blocks, false-positive results, and technical aspects -which were all lacking (280). It is very interesting that Leclaire is the second author of the manuscript published by Carette et al (286), which is considered as a standard for negative response to treatment and also for positive response with sodium chloride solution injected into a closed space.…”

In Response: From Manchikanti et al

“…Finally, there was no placebo control. Interestingly enough, in response to Gauci's (38) request, Leclaire et al (39) acknowledged multiple deficiencies. They described that their study used an invalidated and dated approach (30,40), and acknowledged the value of controlled local anesthetic blocks, false-positive results and technical aspects -which were all lacking (39).…”