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Review
. 2024 Sep;14(7):2124-2154.
doi: 10.1177/21925682241230922. Epub 2024 Feb 6.

Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline

Stephan Klessinger  1   2 , Hans-Raimund Casser  3 , Sebastian Gillner  4 , Holger Koepp  5 , Andreas Kopf  6 , Martin Legat  7 , Katharina Meiler  8 , Heike Norda  9 , Markus Schneider  10 , Matti Scholz  11 , Phillipp J Slotty  12 , Volker Tronnier  13 , Martin Vazan  14 , Karsten Wiechert  15
Affiliations
Review

Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline

Stephan Klessinger et al. Global Spine J. 2024 Sep.

Abstract

Study design: Systematic review of the literature and subsequent meta-analysis for the development of a new guideline.

Objectives: This manuscript summarizes the recommendations from a new clinical guideline published by the German Spine Society. It covers the current evidence on recommendations regarding the indication, test blocks and use of radiofrequency denervation. The guidelines aim is to improve patient care and efficiency of the procedure.

Methods: A multidisciplinary working group formulated recommendations based on the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

Results: 20 clinical questions were defined for guideline development, with 87.5% consensus achieved by committee members for one recommendation and 100% consensus for all other topics. Specific questions that were addressed included clinical history, examination and imaging, conservative treatment before injections, diagnostic blocks, the injected medications, the cut-off value in pain-reduction for a diagnostic block as well as the number of blocks, image guidance, the cannula trajectories, the lesion size, stimulation, repeat radiofrequency denervation, sedation, cessation or continuation of anticoagulants, the influence of metal hardware, and ways to mitigate complications.

Conclusion: Radiofrequency (RF) denervation of the spine and the SI joint may provide benefit to well-selected individuals. The recommendations of this guideline are based on very low to moderate quality of evidence as well as professional consensus. The guideline working groups recommend that research efforts in relation to all aspects of management of facet joint pain and SI joint pain should be intensified.

Keywords: back pain; chronic spinal pain; facet joint; medial branch block; neck pain; radiofrequency denervation; sacroiliac joint; spine intervention.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Potential conflicts of interest have been declared by all involved partners and made publicly available on the webpage of The Association of the Scientific Medical Societies of Germany (AWMF): https://register.awmf.org/de/leitlinien/detail/004-151. No member of the guideline developing group had a high risk of conflict of interest.

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References

    1. Klessinger S. Facet joint pain: Presentation and treatment. Is it a myth? In: Pinheiro-Franco JL, Vaccaro AR, Benzel EC, Mayer HM, eds. Advanced Concepts in Lumbar Degenerative Disk Disease. Heidelberg: Springer; 2016.
    1. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011;12(2):224-233. doi:10.1111/j.1526-4637.2010.01045.x - DOI - PubMed
    1. Schuster NM, Clements ND, Suri P, Stojanovic MP. Is this spine pain facetogenic? Addressing diagnostic myths. Pain Med. 2021;22(Suppl 1):S31. doi:10.1093/pm/pnab097 - DOI - PubMed
    1. Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467. doi:10.1136/rapm-2019-101243 - DOI - PMC - PubMed
    1. Schneider BJ, Ehsanian R, Rosati R, Huynh L, Levin J, Kennedy DJ. Validity of physical exam maneuvers in the diagnosis of sacroiliac joint pathology. Pain Med. 2020;21(2):255-260. doi:10.1093/pm/pnz183 - DOI - PubMed

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