A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

Laxmaiah Manchikanti^{1

2

3}, Nebojsa Nick Knezevic^{4

5}, Emilija Knezevic⁶, Salahadin Abdi⁷, Mahendra R Sanapati⁸, Amol Soin⁹, Bradley W Wargo¹⁰, Annu Navani¹¹, Sairam Atluri¹², Christopher G Gharibo¹³, Thomas T Simopoulos¹⁴, Radomir Kosanovic¹⁵, Alaa Abd-Elsayed¹⁶, Alan D Kaye¹⁷, Joshua A Hirsch¹⁸

Affiliations

¹ Pain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA. drlm@thepainmd.com.
² Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA. drlm@thepainmd.com.
³ Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA. drlm@thepainmd.com.
⁴ Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
⁵ College of Medicine, University of Illinois, Chicago, IL, USA.
⁶ College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
⁷ Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
⁸ Pain Management Centers of America, Evansville, IN, USA.
⁹ Ohio Pain Clinic and Wright State University, Dayton, OH, USA.
¹⁰ Interventional Pain Management, Mays & Schnapp Neurospine & Pain, Memphis, TN, USA.
¹¹ Comprehensive Spine & Sports Center and Le Reve Regenerative Wellness, Campbell, CA, USA.
¹² Tri-State Spine Care Institute, Cincinnati, OH, USA.
¹³ Pain Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁴ Department of Anesthesiology, Critical Care and Pain Medicine, Arnold Warfield Pain Management Center, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA.
¹⁵ Pain Management Centers of America, Paducah, KY, USA.
¹⁶ UW Health Pain Services and UW Pain Clinic, Chronic Pain Medicine, Department of Anesthesiology, and University of Wisconsin School of Medicine and Public Health,, Madison, WI, USA.
¹⁷ Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSUHSC, Shreveport, LA, USA.
¹⁸ Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

PMID: 36422818
PMCID: PMC9686245
DOI: 10.1007/s40122-022-00455-0

Review

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

Laxmaiah Manchikanti et al. Pain Ther. 2023 Feb.

. 2023 Feb;12(1):19-66.

doi: 10.1007/s40122-022-00455-0. Epub 2022 Nov 24.

Authors

Affiliations

¹ Pain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA. drlm@thepainmd.com.
² Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA. drlm@thepainmd.com.
³ Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA. drlm@thepainmd.com.
⁴ Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
⁵ College of Medicine, University of Illinois, Chicago, IL, USA.
⁶ College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
⁷ Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
⁸ Pain Management Centers of America, Evansville, IN, USA.
⁹ Ohio Pain Clinic and Wright State University, Dayton, OH, USA.
¹⁰ Interventional Pain Management, Mays & Schnapp Neurospine & Pain, Memphis, TN, USA.
¹¹ Comprehensive Spine & Sports Center and Le Reve Regenerative Wellness, Campbell, CA, USA.
¹² Tri-State Spine Care Institute, Cincinnati, OH, USA.
¹³ Pain Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
¹⁴ Department of Anesthesiology, Critical Care and Pain Medicine, Arnold Warfield Pain Management Center, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA.
¹⁵ Pain Management Centers of America, Paducah, KY, USA.
¹⁶ UW Health Pain Services and UW Pain Clinic, Chronic Pain Medicine, Department of Anesthesiology, and University of Wisconsin School of Medicine and Public Health,, Madison, WI, USA.
¹⁷ Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSUHSC, Shreveport, LA, USA.
¹⁸ Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

PMID: 36422818
PMCID: PMC9686245
DOI: 10.1007/s40122-022-00455-0

Abstract

Background: Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks.

Study design: Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis.

Objective: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain.

Methods: Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined.

Results: Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is level II in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was level III to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions.

Limitations: There was a paucity of literature and heterogeneity among the available studies.

Conclusion: This systematic review and meta-analysis shows level II evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with level III to IV evidence in managing cervicogenic headaches.

Keywords: Cervical facet or zygapophysial joint pain; Chronic spinal pain; Controlled comparative local anesthetic blocks; Diagnostic accuracy; Facet joint nerve blocks; Radiofrequency neurotomy.

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Figures

**Fig. 1**
Flow diagram illustrating the results of literature search conducted to evaluate cervical radiofrequency neurotomy

**Fig. 2**
Single-arm meta-analysis for pain relief at 6-month follow-up: RFA

**Fig. 3**
Single-arm meta-analysis for pain relief at 6-month follow-up: control

**Fig. 4**
Single-arm meta-analysis for pain relief at 12-month follow-up: RFA

**Fig. 5**
Single-arm meta-analysis for pain relief at 12-month follow-up: control

See this image and copyright information in PMC

References

1. U.S. Burden of Disease Collaborators. The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608. 10.1001/jama.2013.13805. - PMC - PubMed
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1. Manchikanti L, Kaye AD, Soin A, et al. Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2020;23(3S):S1–127. - PubMed
1. Navani A, Manchikanti L, Albers SL, et al. Responsible, safe, and effective use of biologics in the management of low back pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2019;22(1S):S1–74. - PubMed
1. Manchikanti L, Knezevic NN, Navani A, et al. Epidural interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) comprehensive evidence-based guidelines. Pain Physician. 2021;24(S1):S27–S208. - PubMed

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A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

Affiliations

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

Authors

Affiliations

Abstract

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References

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LinkOut - more resources

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