Interventional Minimally Invasive Treatments for Chronic Low Back Pain Caused by Lumbar Facet Joint Syndrome: A Systematic Review
Luca Ambrosio, Gianluca Vadalà, Fabrizio Russo, Giuseppe Pascarella, Sergio De Salvatore, Giuseppe Francesco Papalia, Alessandro Ruggiero, Marta Di Folco, Massimiliano Carassiti, Rocco Papalia, Vincenzo Denaro
Abstract
STUDY DESIGN: Systematic review. OBJECTIVE: To investigate the efficacy of nonsurgical interventional treatments for chronic low back pain (LBP) caused by facet joint syndrome (FJS). METHODS: A systematic review of the literature was conducted to identify studies that compared interventional treatments for LBP due to FJS among them, with usual care or sham procedures. Studies were evaluated for pain, physical function, disability, quality of life and employment status. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. RESULTS: Eighteen studies published between January 2000 and December 2021 were included (1496 patients, mean age: 54.31 years old). Intraarticular (IA) facet joint (FJ) injection of hyaluronic acid (HA) did not show significant difference compared to IA corticosteroids (CCS) in terms of pain and satisfaction. FJ denervation using radiofrequency (RF) displayed slightly superior or similar outcomes compared to IA CCS, physical therapy, or sham procedure. IA CCS showed better outcomes when combined with oral diclofenac compared to IA CCS or oral diclofenac alone but was not superior to IA local anesthetic and Sarapin. IA platelet-rich plasma (PRP) led to an improvement of pain, disability and satisfaction in the long term compared to IA CCS. CONCLUSION: FJS is a common cause of LBP that can be managed with several different strategies, including nonsurgical minimally invasive approaches such as IA HA, CCS, PRP and FJ denervation. However, available evidence showed mixed results, with overall little short-term or no benefits on pain, disability, and other investigated outcomes.