1. 2012;15;E909-E953An Update of the Effectiveness of Therapeutic Lumbar Facet Joint Interventions
   Systematic Review
   Nalini Sehgal, MD, Stephanie Geffert, MLIS, Obi Onyewu, MD, Jie Zhu, MD, Sareta Coubarous, DO, Sukdeb Datta, MD, Laxmaiah Manchikanti, MD, Frank J.E. Falco, MD, Mariam Hameed, MD, Stephen P. Ward, MD, Manohar Lal Sharma, MD, Haroon Hameed, MD, Vijay Singh, MD, and Mark V. Boswell, MD, PhD.

BACKGROUND: Therapeutic lumbar facet joint interventions are implemented to provide long-term pain relief after the facet joint has been identified as the basis for low back pain. The therapeutic lumbar facet joint interventions generally used for the treatment of low back pain of facet joint origin are intraarticular facet joint injections, lumbar facet joint nerve blocks, and radiofrequency neurotomy.

OBJECTIVE: To evaluate and update the effect of therapeutic lumbar facet joint interventions in managing chronic low back pain.

STUDY DESIGN: A systematic review of therapeutic lumbar facet joint interventions for the treatment of chronic low back pain.

METHODS: The available literature on lumbar facet joint interventions in managing chronic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through June 2012, and manual searches of the bibliographies of known primary and review articles.

OUTCOME MEASURES:The primary outcome measure was pain relief with short-term relief defined as up to 6 months and long-term relief as 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. 

RESULTS: For this systematic review, 122 studies were identified. Of these, 11 randomized trials and 14 observational studies met inclusion criteria for methodological quality assessment.

The evidence for radiofrequency neurotomy is good and fair to good for lumbar facet joint nerve blocks for short- and long-term improvement; whereas the evidence for intraarticular injections and pulsed radiofrequency neurotomy is limited.

LIMITATIONS: The limitations of this systematic review include the continued paucity of evidence, specifically for intraarticular injection therapy.

CONCLUSION: In summary, there is good evidence for the use of conventional radiofrequency neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement.

There is limited evidence for intraarticular facet joint injections and pulsed radiofrequency thermoneurolysis.