Evaluating Radiofrequency Ablation versus Corticosteroid Injections for Facet Joint Syndrome Causing Chronic Lumbar Back Pain: A Systematic Review with Meta-Analysis of Randomized-Controlled Trials

Evaluating Radiofrequency Ablation versus Corticosteroid Injections for Facet Joint Syndrome Causing Chronic Lumbar Back Pain: A Systematic Review with Meta-Analysis of Randomized-Controlled Trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating Radiofrequency Ablation versus Corticosteroid Injections for Facet Joint Syndrome Causing Chronic Lumbar Back Pain: A Systematic Review with Meta-Analysis of Randomized-Controlled Trials Justin Le, Han Jie Liu, Andrew Atschinow, Lisa Huang, Jason Tran, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6387470/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Facet joint syndrome (FJS) is a common cause of chronic lumbar back pain (CLBP), significantly impacting patients' quality of life. Among therapies available, radiofrequency ablation (RFA) and corticosteroid injections are widely used; however, limited comparative evidence exists regarding their efficacy, especially for chronic cases affecting the lumbar spine. Therefore, this study seeks to evaluate the effectiveness of radiofrequency ablation and corticosteroid injections in treating facet joint syndrome-related chronic lumbar back pain. Methods A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and Scopus was conducted to identify controlled trials evaluating RFA or corticosteroid injections. The primary outcomes measured were Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores at 3 and 6 months. Results Both RFA and corticosteroid injections demonstrated significant improvements in ODI and VAS scores at 3 months (p < 0.001). At 6 months, RFA maintained effectiveness in ODI scores (p = 0.008), while corticosteroid injections showed borderline significance (p = 0.06). Corticosteroids provided greater VAS improvement at 6 months compared to RFA (p = 0.03), though RFA exhibited better-sustained efficacy overall. Conclusion Both RFA and corticosteroid injections are effective treatments for FJS-related CLBP, with RFA providing longer functional benefits and corticosteroid injections providing better pain reduction over time. However, differences in methodologies, patient populations, and intervention protocols highlight the need for further research to clarify their nuanced efficacy for particular situations. chronic pain facet joint syndrome radiofrequency ablation corticosteroids interventional pain management lumbar spine Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Chronic lumbar back pain (CLBP) is one of the most pervasive and debilitating conditions affecting people worldwide, significantly impacting quality of life, functional ability, and overall productivity. The World Health Organization classifies low back pain as a leading cause of disability, with some estimates placing its lifetime prevalence as high as 80%.[ 1 – 3 ] Among the many potential contributors to CLBP, facet joint syndrome (FJS) is a particularly significant yet often overlooked etiology, accounting for 15–45% of cases.[ 4 , 5 ] FJS arises from dysfunction or degeneration of the lumbar facet joints— the synovial articulations responsible for spinal stability and controlled motion.[ 6 ] These joints are crucial in distributing mechanical loads and allowing mobility, but when negatively impacted, they can become a significant source of pain and functional limitation.[ 7 ] The pathophysiology of FJS-related pain is complex and multifactorial. Mechanical stress, inflammatory processes, and neural hyper-sensitization are all contributing factors.[ 8 ] Mechanical stress on the facet joints can result from repetitive motion, poor posture, trauma, or degenerative changes, leading to microtrauma and subsequent inflammation.[ 9 ] This inflammatory response triggers the release of pro-inflammatory cytokines, which further sensitize local nociceptors, amplifying pain.[ 10 – 12 ] Most challenging is that the clinical presentation of FJS often overlaps with other spinal pathologies– including discogenic pain, radiculopathy, and spinal stenosis– which complicates the diagnostic process and may lead to inappropriate treatment approaches.[ 13 ] Given the prevalence of FJS and its impact on patients, effective management strategies are critical. Two of the most commonly utilized interventions for FJS are radiofrequency ablation (RFA) and corticosteroid injections.[ 14 , 15 ] RFA is a minimally invasive procedure that applies thermal energy to the medial branch nerves supplying the facet joints, to disrupt pain transmission.[ 16 , 17 ] This method has been shown to provide significant and sustained pain relief for many patients with FJS, particularly those who do not respond adequately to conservative management.[ 18 – 20 ] Clinical studies have demonstrated that RFA can result in meaningful reductions in pain and improvements in function, making it a widely adopted approach in pain management.[ 21 , 22 ] On the other hand, corticosteroid injections serve as a direct anti-inflammatory intervention targeting the facet joints. By reducing intra-articular inflammation, these injections provide rapid pain relief, which can be particularly useful for patients experiencing acute exacerbations.[ 23 , 24 ] However, while corticosteroid injections offer quick symptomatic relief, their effects are often transient, necessitating repeated administrations for prolonged benefit.[ 25 , 26 ] Despite their widespread use, the efficacy of corticosteroid injections varies considerably depending on patient-specific factors, disease severity, and technical execution.[ 27 , 28 ] Although both RFA and corticosteroid injections are widely implemented in clinical practice, there is a notable gap in high-quality, comparative research specifically evaluating their efficacy for lumbar FJS, especially causing prolonged, chronic pain. Most studies to date have focused on either RFA or corticosteroid injections in isolation, with few head-to-head comparisons assessing their relative effectiveness. This is especially true with chronic cases of lumbar pain due to FJS.[ 29 , 30 ] This lack of direct comparative data creates a challenge for clinicians seeking to optimize treatment strategies, as patient response to these interventions can be highly variable.[ 31 – 34 ] Therefore, this study aims to systematically review and analyze existing literature comparing the outcomes of RFA and corticosteroid injections for lumbar FJS. Following PRISMA 2020 guidelines, a systematic review and meta-analysis were conducted, focusing on pain reduction measured by the Visual Analog Scale (VAS) and functional improvements assessed using the Oswestry Disability Index (ODI) at 3- and 6-month follow-up intervals. By synthesizing randomized-controlled trials within the past twenty years, this study seeks to provide a better understanding of the comparative effectiveness of these two treatment modalities for managing CLBP due to FJS. METHODS Search Strategy A comprehensive literature search was done on five major databases – PubMed, Cochrane, Web of Science, Embase, and Scopus – using this search string: (("Corticosteroid Injections" OR "Steroid Injections" OR "Epidural Steroid Injections" OR "Facet Joint Injections") OR ("Radiofrequency Ablation" OR “RFA” OR “Radiofrequency Neurotomy”)) AND ("Facet Joint Syndrome" OR "Facet Joint Pain" OR “Facet Syndrome" OR "Zygapophyseal Joint Pain" OR “Zygapophysial Joint Pain”) AND (“Chronic low back pain” OR “CLBP” OR “Chronic Spinal Pain” OR “Chronic back pain” OR “persistent back pain” OR “refractory back pain” OR “neck pain” OR “chronic pain” OR “spinal pain”). Inclusion/Exclusion Criteria These were the inclusion criteria– 1. Studies: only RCTs; 2. participants: adult patients diagnosed with facet joint syndrome of the lumbar spine with chronic pain lasting over 3 month; 3. interventions: any form of radiofrequency ablation, corticosteroid injections; and 4. outcome measures: the visual analog scale for pain (0–10, 0 as no pain and 10 as the worst pain) and the Oswestry Disability Index (score reported as a percentage). All studies must have measured outcomes at 3 and 6 months. All cadaveric, animal, and case reports were excluded. All studies that were unable to be accessed or did not adhere to the same outcome measures at the specified time points were excluded. Two independent authors (LH and AR) screened the articles using Rayyan.ai – a web-based tool for organizing and facilitating systematic reviews, according to the established inclusion/exclusion criteria. A third independent researcher resolved any article conflicts (AA). Data Extraction Four independent researchers (JL, LH, JT, AR) performed the data extraction using a standardized data collection form. Data extracted included 1) therapy and location of treatment, 2) measurement outcomes (Visual Analog Scale for Pain (VAS) or Oswestry Disability Index (ODI) – measuring symptoms and function, respectively; and 3) outcome time points at either 3 or 6 months. Certainty of Evidence and Bias Assessment The included articles were assessed for certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria by two independent authors (JL and HJL).[ 35 ] For risk of bias assessment, RoB-2 was used by two independent authors (JL and HJL) to evaluate included articles.[ 36 ] In the case of conflict, (JT) was the tiebreaker. Statistical Analysis A random effects meta-analysis was performed to evaluate the effects of corticosteroid injection and RFA on VAS and ODI in patients with FJS. This analysis was performed using SPSS version 30. The random effects model was selected to account for the anticipated heterogeneity across studies. Individual subgroup analyses were conducted for specific timeframes (3 months and 6 months) to ensure that the VAS and ODI scores were evaluated in a standardized manner across these follow-up periods. This was also carried out to explore 1) whether corticosteroid injections and RFA resulted in significant improvements in VAS and ODI scores and 2) whether the effects of these interventions differed. Cohen's d was extracted as a measure of effect size for each study included in the meta-analysis. An alpha value of 0.05 was selected for statistical significance. RESULTS Article Selection A total of 758 studies were identified from database searches. Following the removal of 404 duplicate articles, 354 underwent screening. Of these, 326 were excluded based on title and abstract review. Full-text retrieval was attempted for 28 articles, but 5 were unavailable. Among the 23 assessed for eligibility, 15 were excluded due to the absence of Visual Analog Scale (VAS) or Other Disability Index (ODI) scores (n = 5), inclusion of mixed treatment groups (n = 4), differing time points (n = 2), or unreported outcomes (n = 4). Ultimately, 8 studies met the inclusion criteria and were incorporated into the final review. These results are summarized in Fig. 1 and Table 1 . Table 1 Summary of Included Studies Intervention Author & Year Study Title Study Design Inclusion Criteria Corticosteroids RFA Sample Size Notes Kroll et al., 2008 A randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome RCT, patient blinded only Patients ≥ 18 years old with history of unilateral/bilateral lumbar back pain ≥ one month; disc herniation/stenosis radiographically excluded CRF: 80°C for 75 seconds: PRF: 42°C, 20-ms pulse duration, 2-Hz pulse rate for 120 seconds N = 13 CRF; N = 13 PRF CRF = continuous RFA; PRF = pulsed RFA Song et al., 2019 Comparison of the Effectiveness of Radiofrequency Neurotomy and Endoscopic Neurotomy of Lumbar Medial Branch for Facetogenic Chronic Low Back Pain: A Randomized Controlled Trial RCT Patients 40–70 years old with ≥ 3-month history of chronic LBP, medication/physiotherapy with no improvement 80°C for 90 seconds per cycle, for 2 cycles N = 20 Xue et al., 2020 Efficacy of conventional and pulsed radiofrequency for treating chronic lumbar facet joint pain RCT Patients ≥ 18 years old with ≥ 3 month history of chronic LBP, failed ≥ 2 months of medication/physiotherapy ERFA and Control: 80°C for 60 seconds then 90°C for 80 seconds N = 30 ERFA; N = 30 Control ERFA: endoscopic-guided RFA; Control: traditional RFA Nath et al., 2008 Percutaneous Lumbar Zygapophysial (Facet) Joint Neurotomy Using Radiofrequency Current, in the Management of Chronic Low Back Pain RCT, patient blinded only Patients ≥ 18 years old with ≥ 24 month history of chronic LBP; must have ≥ 1 pain component attributed to lumbar FJS 85°C for 60 seconds then 60°C per lesion N = 20 Manchikanti et al., 2011 A Randomized, Controlled, Double-Blind Trial of Fluoroscopic Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation and Radiculitis RCT Patients ≥ 18 years old with ≥ 6 month history of chronic LBP Group 1: 9 mL lidocaine with 6 mg betamethasone (particulate); Group 2: 9 mL lidocaine with 6 mg betamethasone (nonparticulate); Group 3: 9 mL lidocaine with 40 mg depomethyprednisone; all followed by 2 mL 0.9% saline N = 60 Manchikanti et al., 2009 A Comparative Effectiveness Evaluation of Percutaneous Adhesiolysis and Epidural Steroid Injections in Managing Lumbar Post Surgery Syndrome: A Randomized, Equivalence Controlled Trial RCT, patient blinded only Patients ≥ 18 years old with ≥ 6 month history of chronic LBP and ≥ 6 month duration of lumbar surgery in past 6 mL 10% sodium chloride, then 6 mg of non-particulate betamethasone, followed by 1 mL of normal saline N = 60 Ribeiro et al., 2013 Effect of Facet Joint Injection Versus Systemic Steroids in Low Back Pain RCT Patients aged between 18–80 years old, diagnosed with lumbar FJS with CLBP for ≥ 3 months 6 bilateral injections from L3-S1 of 1 mL of 20 mg triamcinolone hexacetonide, for a total of 120 mg N = 31 Kobt et al., 2022 The role of intra-articular injection of autologous platelet-rich plasma versus corticosteroids in the treatment of synovitis in lumbar facet joint disease RCT, patient blinded only Patients aged 20–40 years old with CLBP ≥ 3 months with no improvement using NSAIDS, etc. 0.5-1 mL of 0.5% lidocaine and 5 mg/mL of betamethasone N = 15 Note . This summary table highlights key aspects of each included article, including author, year, title, study design, treatment characteristics, and participant number. Effect of each intervention In total, 292 patients were included among all 8 RCTs for this analysis. For ODI scores, both corticosteroid injections and RFA demonstrated significant improvements compared to baseline at both follow-up times (3 months and 6 months). All effects are summarized in the forest plots in Figs. 2a-d. Pain and Function at 3 Months In terms of ODI, the effect size for corticosteroid injections was (d = -1.46, p < 0.01), with no significant difference in the effectiveness between treatments (Q = 0.76, p = 0.38). For VAS scores, both corticosteroid injections and RFA demonstrated significant improvements compared to baseline. Corticosteroid injections (d = -2.17, p < 0.01) and RFA (d = -3.17, p < 0.01) showed strong efficacy in reducing pain. Pain and Function at 6 Months For ODI, RFA maintained a consistent significant effect (d = -3.36, p = 0.03), demonstrating sustained efficacy over time. Corticosteroid injections showed marginal improvements in ODI scores (d = -1.72, p = 0.01), suggesting a slightly negative trend toward continued efficacy. Similar to the 3-month data, there was no significant difference in efficacy between the two treatments at 6 months (Q = 1.13, p = 0.29). For VAS scores, both corticosteroid injections (d = -1.96, p < 0.01) and RFA (d = -3.78, p < 0.01) demonstrated sustained efficacy. Heterogeneity Testing Heterogeneity was assessed using Cochran’s Q test, I² statistic, and Tau-squared (τ²) in SPSS. The Q statistic (Q = 88.14, df = 5, p < 0.001) revealed significant heterogeneity among all studies. The I² value was 99%, indicating substantial variability among studies. Additionally, Tau-squared (τ² = 13.40) and H-squared (H² = 115.29) confirmed the presence of between-study heterogeneity, supporting the use of a random-effects model. Further subgroup analysis was performed based on treatment types and time points (3-month and 6-month follow-ups) for the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) outcomes. For ODI at 3 months, there was an I² of 84%, indicating high heterogeneity. At 6 months, there was an even higher I² of 99%. For VAS at 3 and 6 months, there were I² of 95% and I² of 93%, respectively. A test for between-subgroup heterogeneity was performed, yielding a non-significant result for ODI at 3 months (Q = 0.76, df = 1, p = 0.38) and 6 months (Q = 1.13, df = 1, p = 0.29), suggesting that treatment type did not significantly contribute to heterogeneity. For VAS, the between-subgroup heterogeneity was also non-significant at 3 months (Q = 0.76, df = 1, p = 0.38), but reached significance at 6 months (Q = 4.76, df = 1, p = 0.03), indicating that treatment differences may have influenced long-term pain reduction outcomes. Certainty of Evidence and Risk of Bias Assessment Figure 3 was created using ROBVIS online tool, depicting results of risk of bias assessment. Some articles demonstrated some concern for outcome measurement due to single blinding. Overall, it was deemed that this did not impact the overall risk of the articles, in which all were considered low. Aside from risk of bias, an assessment of quality was also conducted following each domain of the GRADE criteria. Overall, the included studies were deemed to have a high certainty of evidence due to all being RCTs; however, outcomes for ODI at 6 months had moderate certainty of evidence due to a smaller number of studies represented, Table 2 . Funnel plot analysis also confirmed each article to be of high quality, except for ODI at 6 months, which demonstrated asymmetry, suggesting some publication bias; otherwise, all articles demonstrate good confidence that the true effect is close to the estimated effect of the study, Fig. 4 a-d. Table 2 Certainty assessment using GRADE analysis for selected studies Participants (Studies) Risk of Bias Inconsistency Indirectness Imprecision Other Considerations Overall Certainty of Evidence Pain measured using VAS at 3 months n = 6 RCTs Not serious (0) Serious (-1) Not serious (0) Not serious (0) None High ⨁⨁⨁⨁ Pain measured using VAS at 6 months n = 5 RCTs Not serious (0) Serious (-1) Not serious (0) Not serious (0) None High ⨁⨁⨁⨁ Function measured using ODI at 3 months n = 4 RCTs Not serious (0) Serious (-1) Not serious (0) Not serious (0) None High ⨁⨁⨁⨁ Function measured using ODI at 6 months n = 4 RCTs Serious (-1) Serious (-1) Not serious (0) Not serious (0) None Moderate ⨁⨁⨁ Note. The studies were deemed low risk, with all using appropriate patients, though high heterogeneity was found. Measurements were accurately taken and thoroughly reported, with no other relevant considerations. DISCUSSION Overall, our systematic review and meta-analysis provide evidence regarding the efficacy of radiofrequency ablation (RFA) and corticosteroid injections for managing facet joint syndrome (FJS) that causes chronic low back pain (CLBP). Both treatments demonstrated improvements in pain and disability, as evidenced by Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores at both 3- and 6-months post-treatment. Notably, corticosteroid injections exhibited a greater improvement in VAS scores at the 6-month mark compared to RFA, although both treatments were effective in improving symptoms. The findings of this review align with previous studies that have explored various other interventional approaches for FJS. For instance, autologous platelet-rich plasma (PRP) injections have been highlighted as a potential treatment, offering reparative benefits for lumbar FJS and suggesting that PRP could enhance treatment outcomes when administered at optimal platelet concentrations. [ 3 ] Furthermore, factors such as accurate diagnosis through patient history and physical examination is also crucial for selecting appropriate candidates for these interventions. [ 37 ] Moreover, the comparative effectiveness of RFA and corticosteroid injections is supported by research examining the role of ultrasound-guided techniques in enhancing the precision of facet joint injections, thereby improving patient outcomes. [ 38 ] Additionally, some evidence suggests that combining RFA with steroid nerve blocks may yield superior results in managing lumbar facet arthropathy, indicating that hybrid approaches could be beneficial. [ 39 ] Despite the positive outcomes associated with both treatments, the high heterogeneity observed across the included studies raises important considerations regarding the methodologies, patient populations, and intervention protocols employed. This variability underscores the necessity for future research to standardize treatment protocols and outcome measures, which would facilitate more robust comparisons and enhance the generalizability of findings. In summary, our study reinforces the notion that both RFA and corticosteroid injections are effective interventions for CLBP stemming from FJS. However, the observed heterogeneity and the evolving landscape of treatment options necessitate ongoing investigation to optimize therapeutic strategies and improve patient outcomes. Clinicians should consider these findings when discussing treatment options with patients, allowing for a more personalized approach to pain management. Ultimately, further research into the long-term efficacy and safety of these interventions will be crucial in informing clinical practice and enhancing the quality of life for patients suffering from chronic low back pain. CONCLUSION This systematic review and meta-analysis provide evidence supporting the effectiveness of both RFA and corticosteroid injections for managing FJS causing CLBP. Both interventions significantly improved VAS and ODI scores at 3 and 6 months. Interestingly, corticosteroid injections showed a greater reduction in VAS scores at the 6-month follow-up, suggesting potential benefits for longer-term pain relief; while RFA was better in maintaining improved function at 6 months. These findings can help guide clinical decision making, whether it be for longer sustained pain relief versus function. However, high heterogeneity among included studies underscores the need for standardized protocols and further comparative trials to refine treatment selection criteria. Future research should focus on optimizing treatment protocols through conducting more high-powered, large-scale RCTs to further elucidate the comparative effectiveness of these interventions. Declarations The authors have no relevant financial or non-financial interests to disclose. Author Contribution J.L. oversaw and contributed to every aspect of the project, including article selection, data collection, statistics, manuscript writing, risk of bias, grading, and review. H.L. contributed to statistics, manuscript writing, risk of bias, grading, and review. A.A. was involved in tiebreaking the articles, data collection, and review. L.H. was involved in screening, data collection, and review. J.T. was involved in screening the articles, data collection, tiebreaking for risk of bias and grading, and review. A.R. was involved in data collection and review. G.S. oversaw the project, offered guidance, and served as the principal investigator. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6387470","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441017587,"identity":"d79bdfa9-ce0d-47af-b27c-ca867132cca5","order_by":0,"name":"Justin Le","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie2PsUoEMRCGRwRtFq4diGyeQMgSWC3kfAvrHIJp9mCrYzsXBJ/hYAtfwePg6kDgqjyAoIUiXB0QrCycvVyb2ysF80HIMMzH/AOQSPxFEOAY4JIqQ09A3jfN+x4jCwoGxQiQW0UdpgRr0vbFPuWaPWw+a8Acjpz88vWbfrqxH7RlnJ+3kS1n6ws5B6Q8rkQjNtPF650g5VaWJhZMlSwDpDyupFvsdNGpXjGTVVTR371yT4r0pOii035AqbZb6F4nKJhVnFUDW16qGcsEFo+wnqETtnhmVW2UiN9yOtcrljVXfIR26Zsfy3mnl9434zymBATACe4mhNl1hhm14eftIdOJRCLxn/gFXtVa/qglM1EAAAAASUVORK5CYII=","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":true,"prefix":"","firstName":"Justin","middleName":"","lastName":"Le","suffix":""},{"id":441017588,"identity":"4d0e3431-2823-4491-92d0-090b7a424c4e","order_by":1,"name":"Han Jie Liu","email":"","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"Jie","lastName":"Liu","suffix":""},{"id":441017589,"identity":"dd045431-5419-4cc3-82e5-3feb709c9b2a","order_by":2,"name":"Andrew Atschinow","email":"","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Atschinow","suffix":""},{"id":441017590,"identity":"0ed8e94d-0453-47e7-b506-a5940494efba","order_by":3,"name":"Lisa Huang","email":"","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Huang","suffix":""},{"id":441017591,"identity":"7e7451f4-cd65-4d76-951e-b40feb825001","order_by":4,"name":"Jason Tran","email":"","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Jason","middleName":"","lastName":"Tran","suffix":""},{"id":441017594,"identity":"ba0fef79-5aa3-4aca-bea4-4d83f28f4c74","order_by":5,"name":"Anish Rana","email":"","orcid":"","institution":"Futures Forward Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Anish","middleName":"","lastName":"Rana","suffix":""},{"id":441017595,"identity":"af648270-5da0-4279-a1c5-5600226fb836","order_by":6,"name":"Gilbert Siu","email":"","orcid":"","institution":"Rowan-Virtua School of Osteopathic Medicine","correspondingAuthor":false,"prefix":"","firstName":"Gilbert","middleName":"","lastName":"Siu","suffix":""}],"badges":[],"createdAt":"2025-04-06 15:08:08","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6387470/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6387470/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81967881,"identity":"e2d23edd-9ac8-4823-85d2-e23eeb005ec8","added_by":"auto","created_at":"2025-05-05 11:45:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":451391,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eArticle Selection Flow Diagram Defined By PRISMA 2020\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6387470/v1/cbbbb3cf693d8a14d30e1641.jpeg"},{"id":81966535,"identity":"267a91ef-0b24-484d-918a-368e5d8e8499","added_by":"auto","created_at":"2025-05-05 11:37:05","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172805,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a-d). Forest plots with sub-group analysis of included studies at 3 and 6 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Figures 2a and 2b are the 3- and 6-month VAS outcomes, respectively; while figure 2c and 2d are ODI outcomes at 3- and 6-months, respectively. Treatment 1 represents RFA, whereas treatment 2 represents corticosteroid injections.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6387470/v1/55241bc7e1ad4ee643f5a97b.jpeg"},{"id":81966543,"identity":"e2798966-3db2-4735-b1fc-281827a7df10","added_by":"auto","created_at":"2025-05-05 11:37:05","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":279717,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRoB-2 traffic light plot\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6387470/v1/769e6424679ffbc9c8791478.jpeg"},{"id":81968189,"identity":"d5a34734-107e-43ba-b48a-5d3481a663f6","added_by":"auto","created_at":"2025-05-05 11:53:05","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":121383,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a-d). Funnel plot of VAS and ODI outcomes at 3,6 months\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. \u003c/em\u003eFigures 4a and 4b demonstrate funnel plots for VAS scores at 3 and 6 months, respectively. Similarly, figures 4c and 4d represent funnel plots for ODI scores at 3 and 6 months, respectively.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6387470/v1/b03979267c3a22eb70bfbc66.jpeg"},{"id":94940271,"identity":"31e76226-be79-4cc5-bf32-1b6699f65eba","added_by":"auto","created_at":"2025-11-02 06:08:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1859875,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6387470/v1/823e68dc-82cb-4381-892b-ae164e8cb6f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating Radiofrequency Ablation versus Corticosteroid Injections for Facet Joint Syndrome Causing Chronic Lumbar Back Pain: A Systematic Review with Meta-Analysis of Randomized-Controlled Trials","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChronic lumbar back pain (CLBP) is one of the most pervasive and debilitating conditions affecting people worldwide, significantly impacting quality of life, functional ability, and overall productivity. The World Health Organization classifies low back pain as a leading cause of disability, with some estimates placing its lifetime prevalence as high as 80%.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Among the many potential contributors to CLBP, facet joint syndrome (FJS) is a particularly significant yet often overlooked etiology, accounting for 15\u0026ndash;45% of cases.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] FJS arises from dysfunction or degeneration of the lumbar facet joints\u0026mdash; the synovial articulations responsible for spinal stability and controlled motion.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] These joints are crucial in distributing mechanical loads and allowing mobility, but when negatively impacted, they can become a significant source of pain and functional limitation.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe pathophysiology of FJS-related pain is complex and multifactorial. Mechanical stress, inflammatory processes, and neural hyper-sensitization are all contributing factors.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Mechanical stress on the facet joints can result from repetitive motion, poor posture, trauma, or degenerative changes, leading to microtrauma and subsequent inflammation.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This inflammatory response triggers the release of pro-inflammatory cytokines, which further sensitize local nociceptors, amplifying pain.[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Most challenging is that the clinical presentation of FJS often overlaps with other spinal pathologies\u0026ndash; including discogenic pain, radiculopathy, and spinal stenosis\u0026ndash; which complicates the diagnostic process and may lead to inappropriate treatment approaches.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGiven the prevalence of FJS and its impact on patients, effective management strategies are critical. Two of the most commonly utilized interventions for FJS are radiofrequency ablation (RFA) and corticosteroid injections.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] RFA is a minimally invasive procedure that applies thermal energy to the medial branch nerves supplying the facet joints, to disrupt pain transmission.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] This method has been shown to provide significant and sustained pain relief for many patients with FJS, particularly those who do not respond adequately to conservative management.[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Clinical studies have demonstrated that RFA can result in meaningful reductions in pain and improvements in function, making it a widely adopted approach in pain management.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOn the other hand, corticosteroid injections serve as a direct anti-inflammatory intervention targeting the facet joints. By reducing intra-articular inflammation, these injections provide rapid pain relief, which can be particularly useful for patients experiencing acute exacerbations.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] However, while corticosteroid injections offer quick symptomatic relief, their effects are often transient, necessitating repeated administrations for prolonged benefit.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Despite their widespread use, the efficacy of corticosteroid injections varies considerably depending on patient-specific factors, disease severity, and technical execution.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough both RFA and corticosteroid injections are widely implemented in clinical practice, there is a notable gap in high-quality, comparative research specifically evaluating their efficacy for lumbar FJS, especially causing prolonged, chronic pain. Most studies to date have focused on either RFA or corticosteroid injections in isolation, with few head-to-head comparisons assessing their relative effectiveness. This is especially true with chronic cases of lumbar pain due to FJS.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] This lack of direct comparative data creates a challenge for clinicians seeking to optimize treatment strategies, as patient response to these interventions can be highly variable.[\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTherefore, this study aims to systematically review and analyze existing literature comparing the outcomes of RFA and corticosteroid injections for lumbar FJS. Following PRISMA 2020 guidelines, a systematic review and meta-analysis were conducted, focusing on pain reduction measured by the Visual Analog Scale (VAS) and functional improvements assessed using the Oswestry Disability Index (ODI) at 3- and 6-month follow-up intervals. By synthesizing randomized-controlled trials within the past twenty years, this study seeks to provide a better understanding of the comparative effectiveness of these two treatment modalities for managing CLBP due to FJS.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was done on five major databases \u0026ndash; PubMed, Cochrane, Web of Science, Embase, and Scopus \u0026ndash; using this search string: ((\"Corticosteroid Injections\" OR \"Steroid Injections\" OR \"Epidural Steroid Injections\" OR \"Facet Joint Injections\") OR (\"Radiofrequency Ablation\" OR \u0026ldquo;RFA\u0026rdquo; OR \u0026ldquo;Radiofrequency Neurotomy\u0026rdquo;)) AND (\"Facet Joint Syndrome\" OR \"Facet Joint Pain\" OR \u0026ldquo;Facet Syndrome\" OR \"Zygapophyseal Joint Pain\" OR \u0026ldquo;Zygapophysial Joint Pain\u0026rdquo;) AND (\u0026ldquo;Chronic low back pain\u0026rdquo; OR \u0026ldquo;CLBP\u0026rdquo; OR \u0026ldquo;Chronic Spinal Pain\u0026rdquo; OR \u0026ldquo;Chronic back pain\u0026rdquo; OR \u0026ldquo;persistent back pain\u0026rdquo; OR \u0026ldquo;refractory back pain\u0026rdquo; OR \u0026ldquo;neck pain\u0026rdquo; OR \u0026ldquo;chronic pain\u0026rdquo; OR \u0026ldquo;spinal pain\u0026rdquo;).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion/Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThese were the inclusion criteria\u0026ndash; 1. Studies: only RCTs; 2. participants: adult patients diagnosed with facet joint syndrome of the lumbar spine with chronic pain lasting over 3 month; 3. interventions: any form of radiofrequency ablation, corticosteroid injections; and 4. outcome measures: the visual analog scale for pain (0\u0026ndash;10, 0 as no pain and 10 as the worst pain) and the Oswestry Disability Index (score reported as a percentage). All studies must have measured outcomes at 3 and 6 months. All cadaveric, animal, and case reports were excluded. All studies that were unable to be accessed or did not adhere to the same outcome measures at the specified time points were excluded. Two independent authors (LH and AR) screened the articles using Rayyan.ai \u0026ndash; a web-based tool for organizing and facilitating systematic reviews, according to the established inclusion/exclusion criteria. A third independent researcher resolved any article conflicts (AA).\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eFour independent researchers (JL, LH, JT, AR) performed the data extraction using a standardized data collection form. Data extracted included 1) therapy and location of treatment, 2) measurement outcomes (Visual Analog Scale for Pain (VAS) or Oswestry Disability Index (ODI) \u0026ndash; measuring symptoms and function, respectively; and 3) outcome time points at either 3 or 6 months.\u003c/p\u003e\n\u003ch3\u003eCertainty of Evidence and Bias Assessment\u003c/h3\u003e\n\u003cp\u003eThe included articles were assessed for certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria by two independent authors (JL and HJL).[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] For risk of bias assessment, RoB-2 was used by two independent authors (JL and HJL) to evaluate included articles.[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] In the case of conflict, (JT) was the tiebreaker.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eA random effects meta-analysis was performed to evaluate the effects of corticosteroid injection and RFA on VAS and ODI in patients with FJS. This analysis was performed using SPSS version 30. The random effects model was selected to account for the anticipated heterogeneity across studies. Individual subgroup analyses were conducted for specific timeframes (3 months and 6 months) to ensure that the VAS and ODI scores were evaluated in a standardized manner across these follow-up periods. This was also carried out to explore 1) whether corticosteroid injections and RFA resulted in significant improvements in VAS and ODI scores and 2) whether the effects of these interventions differed. Cohen's d was extracted as a measure of effect size for each study included in the meta-analysis. An alpha value of 0.05 was selected for statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eArticle Selection\u003c/h2\u003e \u003cp\u003eA total of 758 studies were identified from database searches. Following the removal of 404 duplicate articles, 354 underwent screening. Of these, 326 were excluded based on title and abstract review. Full-text retrieval was attempted for 28 articles, but 5 were unavailable. Among the 23 assessed for eligibility, 15 were excluded due to the absence of Visual Analog Scale (VAS) or Other Disability Index (ODI) scores (n\u0026thinsp;=\u0026thinsp;5), inclusion of mixed treatment groups (n\u0026thinsp;=\u0026thinsp;4), differing time points (n\u0026thinsp;=\u0026thinsp;2), or unreported outcomes (n\u0026thinsp;=\u0026thinsp;4). Ultimately, 8 studies met the inclusion criteria and were incorporated into the final review. These results are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor \u0026amp; Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Title\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorticosteroids\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRFA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKroll et al., 2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT, patient blinded only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with history of unilateral/bilateral lumbar back pain\u0026thinsp;\u0026ge;\u0026thinsp;one month; disc herniation/stenosis radiographically excluded\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCRF: 80\u0026deg;C for 75 seconds: PRF: 42\u0026deg;C, 20-ms pulse duration, 2-Hz pulse rate for 120 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e \u003cp\u003eCRF;\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e \u003cp\u003ePRF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCRF\u0026thinsp;=\u0026thinsp;continuous\u003c/p\u003e \u003cp\u003eRFA;\u003c/p\u003e \u003cp\u003ePRF\u0026thinsp;=\u0026thinsp;pulsed RFA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong et al., 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison of the Effectiveness of Radiofrequency Neurotomy and Endoscopic Neurotomy of Lumbar Medial Branch for Facetogenic Chronic Low Back Pain: A Randomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients 40\u0026ndash;70 years old with \u0026ge;\u0026thinsp;3-month history of chronic LBP, medication/physiotherapy with no improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80\u0026deg;C for 90 seconds per cycle, for 2 cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXue et al., 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEfficacy of conventional and pulsed radiofrequency for treating chronic lumbar facet joint pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with \u0026ge;\u0026thinsp;3 month history of chronic LBP, failed\u0026thinsp;\u0026ge;\u0026thinsp;2 months of medication/physiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eERFA and Control: 80\u0026deg;C for 60 seconds then 90\u0026deg;C for 80 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;30 ERFA; N\u0026thinsp;=\u0026thinsp;30 Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eERFA: endoscopic-guided RFA; Control: traditional RFA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNath et al., 2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePercutaneous Lumbar Zygapophysial (Facet) Joint Neurotomy Using Radiofrequency Current, in the Management of Chronic Low Back Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT, patient blinded only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with \u0026ge;\u0026thinsp;24 month history of chronic LBP; must have \u0026ge;\u0026thinsp;1 pain component attributed to lumbar FJS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85\u0026deg;C for 60 seconds then 60\u0026deg;C per lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManchikanti et al., 2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Randomized, Controlled, Double-Blind Trial of Fluoroscopic Caudal Epidural Injections in the Treatment of Lumbar Disc Herniation and Radiculitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with \u0026ge;\u0026thinsp;6 month history of chronic LBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup 1: 9 mL lidocaine with 6 mg betamethasone (particulate); Group 2: 9 mL lidocaine with 6 mg betamethasone (nonparticulate); Group 3: 9 mL lidocaine with 40 mg depomethyprednisone; all followed by 2 mL 0.9% saline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManchikanti et al., 2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA Comparative Effectiveness Evaluation of Percutaneous Adhesiolysis and Epidural Steroid Injections in Managing Lumbar Post Surgery Syndrome: A Randomized, Equivalence Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT, patient blinded only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old with \u0026ge;\u0026thinsp;6 month history of chronic LBP and \u0026ge;\u0026thinsp;6 month duration of lumbar surgery in past\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 mL 10% sodium chloride, then 6 mg of non-particulate betamethasone, followed by 1 mL of normal saline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRibeiro et al., 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffect of Facet Joint Injection Versus Systemic Steroids in Low Back Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients aged between 18\u0026ndash;80 years old, diagnosed with lumbar FJS with CLBP for \u0026ge;\u0026thinsp;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 bilateral injections from L3-S1 of 1 mL of 20 mg triamcinolone hexacetonide, for a total of 120 mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKobt et al., 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe role of intra-articular injection of autologous platelet-rich plasma versus corticosteroids in the treatment of synovitis in lumbar facet joint disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT, patient blinded only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients aged 20\u0026ndash;40 years old with CLBP\u0026thinsp;\u0026ge;\u0026thinsp;3 months with no improvement using NSAIDS, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5-1 mL of 0.5% lidocaine and 5 mg/mL of betamethasone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eNote\u003c/em\u003e. This summary table highlights key aspects of each included article, including author, year, title, study design, treatment characteristics, and participant number.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEffect of each intervention\u003c/h2\u003e \u003cp\u003eIn total, 292 patients were included among all 8 RCTs for this analysis. For ODI scores, both corticosteroid injections and RFA demonstrated significant improvements compared to baseline at both follow-up times (3 months and 6 months). All effects are summarized in the forest plots in \u003cem\u003eFigs.\u0026nbsp;2a-d.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePain and Function at 3 Months\u003c/h2\u003e \u003cp\u003eIn terms of ODI, the effect size for corticosteroid injections was (d = -1.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with no significant difference in the effectiveness between treatments (Q\u0026thinsp;=\u0026thinsp;0.76, p\u0026thinsp;=\u0026thinsp;0.38). For VAS scores, both corticosteroid injections and RFA demonstrated significant improvements compared to baseline. Corticosteroid injections (d = -2.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and RFA (d = -3.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) showed strong efficacy in reducing pain.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePain and Function at 6 Months\u003c/h2\u003e \u003cp\u003eFor ODI, RFA maintained a consistent significant effect (d = -3.36, p\u0026thinsp;=\u0026thinsp;0.03), demonstrating sustained efficacy over time. Corticosteroid injections showed marginal improvements in ODI scores (d = -1.72, p\u0026thinsp;=\u0026thinsp;0.01), suggesting a slightly negative trend toward continued efficacy. Similar to the 3-month data, there was no significant difference in efficacy between the two treatments at 6 months (Q\u0026thinsp;=\u0026thinsp;1.13, p\u0026thinsp;=\u0026thinsp;0.29). For VAS scores, both corticosteroid injections (d = -1.96, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and RFA (d = -3.78, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) demonstrated sustained efficacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHeterogeneity Testing\u003c/h2\u003e \u003cp\u003eHeterogeneity was assessed using Cochran\u0026rsquo;s Q test, I\u0026sup2; statistic, and Tau-squared (τ\u0026sup2;) in SPSS. The Q statistic (Q\u0026thinsp;=\u0026thinsp;88.14, df\u0026thinsp;=\u0026thinsp;5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) revealed significant heterogeneity among all studies. The I\u0026sup2; value was 99%, indicating substantial variability among studies. Additionally, Tau-squared (τ\u0026sup2; = 13.40) and H-squared (H\u0026sup2; = 115.29) confirmed the presence of between-study heterogeneity, supporting the use of a random-effects model.\u003c/p\u003e \u003cp\u003eFurther subgroup analysis was performed based on treatment types and time points (3-month and 6-month follow-ups) for the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) outcomes. For ODI at 3 months, there was an I\u0026sup2; of 84%, indicating high heterogeneity. At 6 months, there was an even higher I\u0026sup2; of 99%. For VAS at 3 and 6 months, there were I\u0026sup2; of 95% and I\u0026sup2; of 93%, respectively.\u003c/p\u003e \u003cp\u003eA test for between-subgroup heterogeneity was performed, yielding a non-significant result for ODI at 3 months (Q\u0026thinsp;=\u0026thinsp;0.76, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.38) and 6 months (Q\u0026thinsp;=\u0026thinsp;1.13, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.29), suggesting that treatment type did not significantly contribute to heterogeneity. For VAS, the between-subgroup heterogeneity was also non-significant at 3 months (Q\u0026thinsp;=\u0026thinsp;0.76, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.38), but reached significance at 6 months (Q\u0026thinsp;=\u0026thinsp;4.76, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;0.03), indicating that treatment differences may have influenced long-term pain reduction outcomes.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCertainty of Evidence and Risk of Bias Assessment\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e was created using ROBVIS online tool, depicting results of risk of bias assessment. Some articles demonstrated some concern for outcome measurement due to single blinding. Overall, it was deemed that this did not impact the overall risk of the articles, in which all were considered low.\u003c/p\u003e \u003cp\u003eAside from risk of bias, an assessment of quality was also conducted following each domain of the GRADE criteria. Overall, the included studies were deemed to have a high certainty of evidence due to all being RCTs; however, outcomes for ODI at 6 months had moderate certainty of evidence due to a smaller number of studies represented, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Funnel plot analysis also confirmed each article to be of high quality, except for ODI at 6 months, which demonstrated asymmetry, suggesting some publication bias; otherwise, all articles demonstrate good confidence that the true effect is close to the estimated effect of the study, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003ea-d.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCertainty assessment using GRADE analysis for selected studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003e(Studies)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRisk of Bias\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInconsistency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndirectness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImprecision\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOther Considerations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOverall Certainty of Evidence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePain measured using VAS at 3 months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e \u003cp\u003eRCTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerious\u003c/p\u003e \u003cp\u003e(-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e⨁⨁⨁⨁\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePain measured using VAS at 6 months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003cp\u003eRCTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerious\u003c/p\u003e \u003cp\u003e(-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e⨁⨁⨁⨁\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFunction measured using ODI at 3 months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eRCTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerious\u003c/p\u003e \u003cp\u003e(-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e⨁⨁⨁⨁\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFunction measured using ODI at 6 months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003eRCTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSerious\u003c/p\u003e \u003cp\u003e(-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSerious\u003c/p\u003e \u003cp\u003e(-1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot serious (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003e⨁⨁⨁\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e The studies were deemed low risk, with all using appropriate patients, though high heterogeneity was found. Measurements were accurately taken and thoroughly reported, with no other relevant considerations.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOverall, our systematic review and meta-analysis provide evidence regarding the efficacy of radiofrequency ablation (RFA) and corticosteroid injections for managing facet joint syndrome (FJS) that causes chronic low back pain (CLBP). Both treatments demonstrated improvements in pain and disability, as evidenced by Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores at both 3- and 6-months post-treatment. Notably, corticosteroid injections exhibited a greater improvement in VAS scores at the 6-month mark compared to RFA, although both treatments were effective in improving symptoms.\u003c/p\u003e \u003cp\u003eThe findings of this review align with previous studies that have explored various other interventional approaches for FJS. For instance, autologous platelet-rich plasma (PRP) injections have been highlighted as a potential treatment, offering reparative benefits for lumbar FJS and suggesting that PRP could enhance treatment outcomes when administered at optimal platelet concentrations. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Furthermore, factors such as accurate diagnosis through patient history and physical examination is also crucial for selecting appropriate candidates for these interventions. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMoreover, the comparative effectiveness of RFA and corticosteroid injections is supported by research examining the role of ultrasound-guided techniques in enhancing the precision of facet joint injections, thereby improving patient outcomes. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] Additionally, some evidence suggests that combining RFA with steroid nerve blocks may yield superior results in managing lumbar facet arthropathy, indicating that hybrid approaches could be beneficial. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite the positive outcomes associated with both treatments, the high heterogeneity observed across the included studies raises important considerations regarding the methodologies, patient populations, and intervention protocols employed. This variability underscores the necessity for future research to standardize treatment protocols and outcome measures, which would facilitate more robust comparisons and enhance the generalizability of findings.\u003c/p\u003e \u003cp\u003eIn summary, our study reinforces the notion that both RFA and corticosteroid injections are effective interventions for CLBP stemming from FJS. However, the observed heterogeneity and the evolving landscape of treatment options necessitate ongoing investigation to optimize therapeutic strategies and improve patient outcomes. Clinicians should consider these findings when discussing treatment options with patients, allowing for a more personalized approach to pain management. Ultimately, further research into the long-term efficacy and safety of these interventions will be crucial in informing clinical practice and enhancing the quality of life for patients suffering from chronic low back pain.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis systematic review and meta-analysis provide evidence supporting the effectiveness of both RFA and corticosteroid injections for managing FJS causing CLBP. Both interventions significantly improved VAS and ODI scores at 3 and 6 months. Interestingly, corticosteroid injections showed a greater reduction in VAS scores at the 6-month follow-up, suggesting potential benefits for longer-term pain relief; while RFA was better in maintaining improved function at 6 months. These findings can help guide clinical decision making, whether it be for longer sustained pain relief versus function. However, high heterogeneity among included studies underscores the need for standardized protocols and further comparative trials to refine treatment selection criteria. Future research should focus on optimizing treatment protocols through conducting more high-powered, large-scale RCTs to further elucidate the comparative effectiveness of these interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.L. oversaw and contributed to every aspect of the project, including article selection, data collection, statistics, manuscript writing, risk of bias, grading, and review. H.L. contributed to statistics, manuscript writing, risk of bias, grading, and review. A.A. was involved in tiebreaking the articles, data collection, and review. L.H. was involved in screening, data collection, and review. J.T. was involved in screening the articles, data collection, tiebreaking for risk of bias and grading, and review. A.R. was involved in data collection and review. G.S. oversaw the project, offered guidance, and served as the principal investigator.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data analyzed in this study were obtained from publicly available published articles referenced in the manuscript. No new data were generated.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShi W, Wang Y, Yu M et al (2017) The comparison of measurement between ultrasound and computed tomography for abnormal degenerative facet joints. 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Pain Med 16(12):2284\u0026ndash;2291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/pme\u003c/span\u003e\u003cspan address=\"10.1111/pme\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chronic pain, facet joint syndrome, radiofrequency ablation, corticosteroids, interventional pain management, lumbar spine","lastPublishedDoi":"10.21203/rs.3.rs-6387470/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6387470/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eFacet joint syndrome (FJS) is a common cause of chronic lumbar back pain (CLBP), significantly impacting patients' quality of life. Among therapies available, radiofrequency ablation (RFA) and corticosteroid injections are widely used; however, limited comparative evidence exists regarding their efficacy, especially for chronic cases affecting the lumbar spine. Therefore, this study seeks to evaluate the effectiveness of radiofrequency ablation and corticosteroid injections in treating facet joint syndrome-related chronic lumbar back pain.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and Scopus was conducted to identify controlled trials evaluating RFA or corticosteroid injections. The primary outcomes measured were Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores at 3 and 6 months.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth RFA and corticosteroid injections demonstrated significant improvements in ODI and VAS scores at 3 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 6 months, RFA maintained effectiveness in ODI scores (p\u0026thinsp;=\u0026thinsp;0.008), while corticosteroid injections showed borderline significance (p\u0026thinsp;=\u0026thinsp;0.06). Corticosteroids provided greater VAS improvement at 6 months compared to RFA (p\u0026thinsp;=\u0026thinsp;0.03), though RFA exhibited better-sustained efficacy overall.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBoth RFA and corticosteroid injections are effective treatments for FJS-related CLBP, with RFA providing longer functional benefits and corticosteroid injections providing better pain reduction over time. However, differences in methodologies, patient populations, and intervention protocols highlight the need for further research to clarify their nuanced efficacy for particular situations.\u003c/p\u003e","manuscriptTitle":"Evaluating Radiofrequency Ablation versus Corticosteroid Injections for Facet Joint Syndrome Causing Chronic Lumbar Back Pain: A Systematic Review with Meta-Analysis of Randomized-Controlled Trials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:37:00","doi":"10.21203/rs.3.rs-6387470/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cdd0aadb-7a25-4a48-a1bf-165e33884ac0","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-02T06:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:37:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6387470","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6387470","identity":"rs-6387470","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}