A systematic review and meta-analysis of the effectiveness of radiofrequency neurotomy in managing chronic neck pain


Laxmaiah Manchikanti, Pain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA. drlm@thepainmd.com.
Nebojsa Nick Knezevic, Advocate Aurora HealthFollow
Emilija Knezevic, College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
Salahadin Abdi, Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.Follow
Mahendra R. Sanapati, Pain Management Centers of America, Evansville, IN, USA.
Amol Soin, Ohio Pain Clinic and Wright State University, Dayton, OH, USA.
Bradley W. Wargo, Interventional Pain Management, Mays & Schnapp Neurospine & Pain, Memphis, TN, USA.
Annu Navani, Comprehensive Spine & Sports Center and Le Reve Regenerative Wellness, Campbell, CA, USA.
Sairam Atluri, Tri-State Spine Care Institute, Cincinnati, OH, USA.Follow
Christopher G. Gharibo, Pain Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
Thomas T. Simopoulos, Department of Anesthesiology, Critical Care and Pain Medicine, Arnold Warfield Pain Management Center, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA.
Radomir Kosanovic, Pain Management Centers of America, Paducah, KY, USA.
Alaa Abd-Elsayed, UW Health Pain Services and UW Pain Clinic, Chronic Pain Medicine, Department of Anesthesiology, and University of Wisconsin School of Medicine and Public Health,, Madison, WI, USA.Follow
Alan D. Kaye, Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSUHSC, Shreveport, LA, USA.
Joshua A. Hirsch, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.


Advocate Illinois Masonic Medical Center


Background: Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks.

Study design: Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis.

Objective: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain.

Methods: Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined.

Results: Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is level II in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was level III to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions.

Limitations: There was a paucity of literature and heterogeneity among the available studies.

Conclusion: This systematic review and meta-analysis shows level II evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with level III to IV evidence in managing cervicogenic headaches.



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