BACKGROUND: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx.METHODS: A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full-text articles were reviewed in duplicate. Included articles were sham-controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow-up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta-analysis was not possible using these data.RESULTS: The present systematic review retrieved 1063 abstracts. Eleven sham-controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed.CONCLUSIONS: While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long-term efficacy of RFA.

中文翻译：

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射频消融治疗慢性下腰痛：随机对照试验的系统评价。

背景：射频消融（RFA）是一种利用热量中断脊神经疼痛信号的方法，是一种针对慢性下腰痛的新兴治疗选择。目的：确定RFA对腰椎小关节，sa关节，椎间盘源性下腰痛和尾骨相关的慢性下腰痛的疗效。方法：进行系统评价。截止到2013年8月，对Medline，EMBASE，PubMed，SPORTDiscus，CINAHL和Cochrane图书馆进行了检索。摘要和全文均进行了复审。纳入的文章为假对照随机对照试验（RCT），评估了RFA的疗效，报告了至少一个月的随访，并包括经历了至少三个月背部疼痛的参与者。重复提取数据，并使用Cochrane偏倚风险工具评估质量。由于异质性，以及缺乏报道的均值差异和标准差，因此无法使用这些数据进行荟萃分析。结果：本系统综述检索了1063篇摘要。包括11个假对照RCT：三项涉及椎间盘源性背痛的研究；六项涉及腰椎小关节疼痛的研究；两项涉及sa关节疼痛的研究。没有研究评估评估尾骨。有证据支持RFA作为腰椎小关节和sa关节疼痛的有效治疗方法，其中六分之五和两个RCT分别显示出统计学上显着的疼痛减轻。支持RFA治疗椎间盘源性疼痛的证据好坏参半。虽然大多数针对腰椎小关节和sa关节的研究表明，RFA可在短期随访中显着减轻疼痛，但椎间盘源性下腰痛的证据基础参差不齐。没有关于尾骨RFA的RCT证据。未来的研究应检查减轻疼痛和RFA的长期疗效的临床意义。