Minimally invasive treatment for lumbar spine related pain disorders

In view of the conflicting evidence for effectiveness of radiofrequency (RF) treatment in patients with chronic low back pain, a study was setup consisting of three sham controlled RCTs investigating the effect of RF treatment of the sacro-iliac (SI) joint, disc and facet joint in terms of pain relief and global perceived effect (GPE). In a fourth study, the inter-rater reliability of the diagnostic parameters of the physical examination was assessed and in a fifth study we evaluated the predictive validity of lumbar X-ray images and MRIs in determining the somatic source of low back pain. Finally, we observed the effectiveness of balloon kyphoplasty (BKP) in patients with painful vertebral compression fractures.
In all three RCTs the pooled data from both groups showed a statistically significant pain reduction between T0 (before the treatment) and T1 (1 month after the treatment). However, the hypothesis (H0) of no differences in terms of pain relief or in GPE between the groups could not be rejected. In other words, when comparing to a sham intervention, percutaneous RF does not lead to a statistically significant more substantial pain reduction, nor to a more substantial GPE.
The inter-rater reliability of the diagnostic tests appeared to be small and this fact seriously limits their predictive validity. The practical value of the tests investigated in patients with low back pain for more than three months thereby seems to be doubtful. Furthermore, the predictive validity (and as such their practical value) of X-ray images and MRIs of the lumbar spine to identify the source of low back pain appears to be doubtful.
In patients with painful (non)malignant vertebral compression fractures, BKP can result in a statistically – and clinically significant pain reduction lasting at least one year.
The main findings from the studies in relation to existing evidence and some methodological challenges are addressed. We close by presenting implications for daily practice and implications for further research.