Rajesh Naidu Janapala, Emilija Knezevic, Nebojsa Nick Knezevic, Rachana Pasupuleti, Mahendra R Sanapati, Alan D Kaye, Vidyasagar Pampati, Sahar Shekoohi, Laxmaiah Manchikanti
{"title":"Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint.","authors":"Rajesh Naidu Janapala, Emilija Knezevic, Nebojsa Nick Knezevic, Rachana Pasupuleti, Mahendra R Sanapati, Alan D Kaye, Vidyasagar Pampati, Sahar Shekoohi, Laxmaiah Manchikanti","doi":"10.1007/s11916-024-01226-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.</p><p><strong>Recent findings: </strong>The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Pain and Headache Reports","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11916-024-01226-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/12 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of review: To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.
Recent findings: The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.
综述目的:通过对随机对照试验(RCT)和观察性研究进行系统回顾和荟萃分析,评估射频神经切断术治疗骶髂关节疼痛的有效性:据估计,骶髂关节疼痛的发病率约占腰痛病例的 25%,其诊断缺乏金标准。治疗方法包括运动疗法、注射、消融术和融合术,但效果不一。COVID-19 改变了包括骶髂关节手术在内的干预措施的使用模式,而这些干预措施的证据仍未确定。最近,美国联邦医疗保险(Medicare)发布了本地承保范围认定(LCD),规定骶髂关节射频神经切断术不在承保范围内。此外,最近一项关于骶髂关节注射的系统性审查显示证据等级为三级或一般。骶髂关节是连接脊柱和骨盆的重要轴向关节,是导致腰痛的原因之一。其复杂的神经支配模式因人而异。骶髂关节功能障碍导致疼痛和僵硬的原因多种多样。本系统综述和荟萃分析旨在通过应用严格的方法学,同时考虑研究性临床试验和观察性研究,评估射频神经切断术治疗骶髂关节疼痛的有效性。尽管在方法上存在差异,但在疼痛评分变化和功能改善的支持下,本综述中的证据表明射频神经切断术作为一种治疗方案具有 III 级证据,建议性尚可。该综述的优势在于其全面的方法和质量评估。然而,局限性依然存在,包括标准和技术因素的差异,这突出表明需要在现实世界中进一步开展高质量的研究。
期刊介绍:
This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.