BACKGROUND: Chronic axial spinal pain is a major cause of disability. The literature shows that expenditures related to low back and neck pain and other musculoskeletal disorders continue to rise, not only due to disability but also due to increasing healthcare costs, accounting for the highest expenditure among various disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain. Therapeutic facet joint interventional modalities for axial spinal pain include radiofrequency ablation, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections.
OBJECTIVE: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency ablation as a therapeutic modality in managing chronic axial spinal pain of facet joint origin.
STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
METHODS: The available literature on radiofrequency ablation in axial spinal pain was reviewed. The quality assessment criteria utilized included the Cochrane review criteria to assess risk of bias and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials. The evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The level of evidence was determined based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.A comprehensive literature search of multiple databases from 1966 to June 2025, including manual searches of the bibliographies of relevant review articles, was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into both qualitative and quantitative analyses.
OUTCOME MEASURES: The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of greater than 50% for at least 6 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).
RESULTS: This assessment identified 17 RCTs, including 14 high-quality and 3 moderate-quality studies based on Cochrane criteria, and 11 high-quality and 6 moderate-quality studies based on IPM-QRB criteria. Based on the GRADE assessment, 8 trials demonstrated at least moderate levels of impact and certainty, whereas 7 trials showed low impact with low certainty, and 2 trials demonstrated very low impact and certainty.
LIMITATIONS: Despite the availability of multiple studies, the relative paucity of high-quality literature remains a major limitation.
CONCLUSION: Based on this systematic review and meta-analysis of 17 RCTs, the evidence is Level II with moderate certainty and a moderate strength of recommendation for the use of radiofrequency ablation in managing chronic axial spinal pain of facet joint origin.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
GRADE criteria have not been properly applied in this systematic review and meta-analysis.
Physician rater
This SR supports RFA within multimodal, function-focused rehabilitation for patients with chronic spinal facet joint pain and reinforces rigorous selection using dual comparative diagnostic blocks. However, the scarcity of high-quality studies and cervical/thoracic trials remain important limitations. Furthermore, local anesthetic in sham arms may attenuate effect sizes.
Physician rater
The study rates facet-joint RFA for chronic spinal pain as having moderate-certainty evidence of effectiveness, mainly due to high heterogeneity. Accurate diagnosis relies on controlled diagnostic medial branch blocks. Implementation is most supported for the lumbar spine since there are very few RCTs from the cervical and thoracic regions.
, McMaster University