Comparison of Radiofrequency and Corticosteroid Injection for Treatment of Lumbar Facet Joint Pain: A Meta-Analysis.

Abstract

BACKGROUND Lumbar facet joint (LFJ) pain was reported to occur in 27%-40% of patients with chronic low back pain (LBP). Several therapeutic procedures such as corticosteroid injection (CI) and radiofrequency (RF) ablation have been used. However, there is no clear consensus that one is superior to the other. This study aimed to perform a meta-analysis to compare the effectiveness of CI and RF ablation for LFJ pain. METHODS This study was conducted by searching for all randomized controlled trials comparing the effect of CI and RF ablation on LFJ pain in Cochrane Central Register of Controlled Trials and PubMed database. We performed inverse-variance weighted meta-analysis of outcomes including pain intensity and functional disability at 3, 6, and 12-month measurement by using RevMan 5.3 (Cochrane, London, England). RESULTS CI was associated with a higher pain intensity score when compared to RF ablation at 3 months (3 trials; standardized mean difference [SMD], 1.09; 95% CI, 0.79 to 1.38; P ＜ 0.00001; I^2 = 96%), at 6 months (7 trials; SMD, 2.10; 95% CI, 0.98 to 3.22; P = 0.00002; I^2 = 96%), and at 12 months (3 trials; SMD, 2.15; 95% CI, -0.26 to 4.56; P = 0.08; I^2 = 98%). The estimated effect of CI on functional disability score at 6 months when CI was compared to RF ablation showed a significant increase (3 trials; MD, 18.78; 95% CI, 16.20 to 21.36; P ＜ 0.00001; I^2 = 98%). CONCLUSIONS Pooled analysis from limited trials showed a benefit of RF to the improvement of pain intensity and functional disability when we compared RF with CI for the treatment of LFJ pain.