Current Concepts | Literature Review Commentary
techniques would prove invaluable in determining the extent
of the shortcomings of their methodology:
Imaging: It is standard care, in performing the minimal
interventional treatments as described under 5. 1, to
make and save radiographic images of the needle positions. Images saved in the Facet RCT will be submitted
to an expert panel to assess correct needle placement.
Retrospectively we will submit all available (
anony-mized) images taken in the Facet RF RCT to a panel,
and have them judged twice, with a 1. 5 month interval.
Both times we will ask the panel to judge the images as
‘correct’ , ‘incorrect’ or ‘unsure’ - needle placement. Out of
this we want to determine an inter- and intra- observer
reliability. If the reliability is high, we will determine
whether ‘correct placement’ , indeed shows a higher pain
reduction (NRS) after 3 months.
Evaluation of the prior literature has already determined
that adequately performed lumbar facet RF improves low
back pain outcomes. In addition to the Dreyfuss study, 3 Lee
and colleagues conducted a meta-analysis of randomized
controlled trials of RF for lumbar facet pain from the last two
decades, and concluded that “conventional radiofrequency
denervation resulted in significant reductions in low back
pain originated from the facet joints in patients showing the
best response to diagnostic blocks.” 7
The results of the Juch et al study indicate nothing more
than what has already been established—RF for lumbar facets
and SIJ is not effective when performed by inadequate “Dutch
community standard” (ie, without valid RF techniques in improperly selected patients). The far-reaching conclusions that
the authors chose to draw from their study, despite the methodological flaws, and the funding from Dutch health insurance
companies pose serious concerns regarding potential bias.
1. Juch JS, Maas ET, Ostelo R G, et al. Effect of radiofrequency
denervation on pain intensity among patients with chronic low
back pain: The mint randomized clinical trials. JAMA. 2017;
2. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N.
The false-positive rate of uncontrolled diagnostic blocks of the
lumbar zygapophysial joints. Pain. 1994;58:195-200.
3. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N.
Efficacy and validity of radiofrequency neurotomy for chronic
lumbar zygapophysial joint pain. Spine. 2000; 25( 10):1270-7.
4. Van Kleef M, Barendse GAM, Kessels A, et al. Randomized trial
of radiofrequency lumbar facet denervation for chronic low back
pain. Spine. 1999; 24( 18):1937-42.
5. Dreyfuss P, Henning T, Malladi N, Goldstein B, Bogduk N.
The ability of multi-site, multi-depth sacral lateral branch
blocks to anesthetize the sacroiliac joint complex. Pain Med.
2009; 10( 4):679-688.
6. DePalma MJ, Ketchum JM, Saullo T. What is the source of
chronic low back pain and does age play a role? Pain Med. 2011
Feb; 12( 2):224-33.
7. Lee CH, Chung CK, Kim CH. The efficacy of conventional
radiofrequency denervation in patients with chronic low
back pain originating from the facet joints: a meta-analysis of
randomized controlled trials. Spine J. 2017. ePub May 30.
HM Guo: Nothing to disclose.
A Stout: Consulting: State Farm. Speaking and/or Teaching
Arrangements: SIS (A, Speaker, Education Division, Program
Planning Committee, Teaching Faculty. Travel expenses and
honoraria); AAPMU (A, Speaker/Faculty. Travel expenses and
honoraria). Trips/Travel: SIS (B).
J Schofferman: Nothing to disclose.
Direct or indirect remuneration: royalties, stock ownership, private
investments, consulting, speaking and/or teaching arrangements, trips/travel.
Position held in a company: board of directors, scientific advisory board, other
office. Support from sponsors: endowments, research–investigator salary,
research–staff and/or materials, grants, fellowship support. Other
Degree of support:
Level A. $100 to $1000 Level F. $100,001 to $500,000
Level B. $1,001 to $10,000 Level G. $500,001 to $1M
Level C. $10,001 to $25,000 Level H. $1,000,001 to $2.5M
Level D. $25,001 to $50,000 Level I. greater than $2.5M
Level E. $50,001 to $100,000