Radiofrequency denervation of spine and SI joint may benefit well-selected individuals: Study

Stephan Klessinger et al conducted a Systematic review of the literature and subsequent meta-analysis for the development of a new guideline. It has been published in ‘Global Spine Journal’.

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.

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.

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 cutoff 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.

The authors concluded – “Clinical trials evaluating RF denervation are characterized by widely disparate outcomes, and there is enormous variation in selecting patients and performing procedures. A multidisciplinary working group developed a national clinical guideline for RF denervation of the spine and the SI joint in adult patients. These multi-society guidelines have been developed to improve outcomes, enhance safety, and minimize unnecessary tests and procedures. The recommendations are based on limited evidence or on consensus but are well aligned with recommendations from similar international guidelines. The guideline working groups strongly recommend that research efforts in relation to all aspects of the management of LBP and RF denervation be intensified.”

Further reading:

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 Journal 2024 DOI: 10.1177/21925682241230922