Volume 181 - Issue 1
Management of chronic low back pain
Author: Nikolai Bogduk
Med J Aust 2004; 181 (1): 55-56. || doi: 10.5694/j.1326-5377.2004.tb06165.x
Published online: 5 July 2004
Published online: 5 July 2004
Nikolai Bogduk
Director, Department of Clinical Research, Royal Newcastle Hospital, David Maddison Building, Newcastle, NSW 2300. mgillamATmail.newcastle.edu.au
In reply: Although systematic reviews have identified three studies of lumbar radiofrequency neurotomy, they do not take into account technical errors in the procedure. Neither the study of Gallagher et al1 nor that of Leclaire et al2 used techniques that could coagulate the target nerves accurately, consistently, and thoroughly.3 Therefore, these studies are not a measure of the efficacy of the procedure when performed correctly and have no place in a systematic review. Nor are systematic reviews permitted to include complementary, observational studies like that of Dreyfuss et al.4 Yet, this study sets the benchmark for what outcomes can be achieved, if and when correct techniques are used.
The “conflicting” evidence reported by systematic reviews arises because inaccurate surgical techniques are used. When studies using inaccurate techniques are eliminated, there is no conflict. The literature reduces to one controlled study5 and one complementary study.4 These were the studies that I cited in the clinical update on chronic low back pain.6 In the face of that literature, the conclusion that I proffered, and which Wenban has quoted, is valid. Zygapophysial joint pain can be relieved by radiofrequency neurotomy. Perhaps the extra words that are required are provided that correct techniques are used.
References
- Gallagher J, Petriccione di Valdo PL, Wedley JR, et al. Radiofrequency facet joint denervation in the treatment of low back pain: a prospective controlled double-blind study to assess its efficacy. Pain Clin 1994; 7: 193-198.
- Leclaire R, Fortin L, Lambert R, et al. Radiofrequency facet joint denervation in the treatment of low back pain. A placebo-controlled clinical trial to assess efficacy. Spine 2001; 26: 1411-1416. i1085569
- Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med 2004. In press. i1085571
- Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000; 25: 1270-1277. i1085573
- van Kleef M, Barendse GAM, Kessels A, et al. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999; 24: 1937-1942. i1085575
- Bogduk N. Management of chronic low back pain. Med J Aust 2004; 180: 79-83. i1085577