Effectiveness and Safety of Radiofrequency Nucleolysis for Chronic or Acute Low Back Pain
Author(s)
Montserrat Carmona, BSc, MSPH, PhD1, Lucía Pedrosa Pérez, PhD.2, Tasmania del Pino Sedeno, PhD.3, Esther E. García Carpintero, PhD.1, Carlos A. Sánchez-Piedra, PhD.1, Lourdes Rodríguez-Rojas, MD.2, Carlos Martin-Saborido, PhD.2.
1Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 2Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 3Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Servicio de Evaluación del Servicio Canario de la Salud (SESCS), La Laguna, Spain.
1Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 2Instituto de Salud Carlos III- Health Technology Assessment Agency (AETS), Madrid, Spain, 3Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Servicio de Evaluación del Servicio Canario de la Salud (SESCS), La Laguna, Spain.
OBJECTIVES: Low back pain (LBP) affected 619 million people worldwide in 2020, with a projected 843 million prevalent cases by 2050. One cause of LBP is the degeneration of the intervertebral disc. Therapeutic options include percutaneous nucleolysis (NL), a minimally invasive technique that reduces intradiscal pressure by heating the nucleus pulposus, which can be achieved using radiofrequency (RF-NL). The aim of this study was to evaluate effectiveness, safety and cost-effectiveness of RF-NL in the treatment of discogenic LBP.
METHODS: A systematic review (SR) of the available scientific literature was conducted to assess the effectiveness, safety, and efficiency of RF-NL in patients with discogenic LBP. Meta-analyses were perfomed with Revman 5.4. The certainty of evidence was assessed using GRADE Pro.
RESULTS: The SR identified a total of 566 records. After applying all inclusion and exclusion criteria, 8 records were selected. Pooled mean difference (PMD) in pain reduction measured by the Visual Analog Scale was 0.32 points (95% CI: 0.10 to 0.54; I2: 0%). Disability were assessed using different questionnaires o scales, PMD was 0.35 points (95% CI: -0.05 to 0.75; I2: 82%). Regarding safety, the risk difference between RF-NL and comparators was not statistically significant (RD: 0.01; 95% CI: -0.02 to 0.03; I2: 0%). Certainty of the evidence was considered to be moderate to very low, depending on the outcome variable analysed
CONCLUSIONS: RF-NL has not been shown to be inferior to NL performed using other techniques (thermal, laser, ozone, mechanical, or platelet-rich plasma), showing comparable effectiveness and safety outcomes. No evidence has been found regarding the cost-effectiveness of RF-NL compared to other therapeutic alternatives.
Financial disclosure: The study is part of the annual work plan of RedETS, which is led by the Spanish Ministry of Health. Several authors are members of the Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).
METHODS: A systematic review (SR) of the available scientific literature was conducted to assess the effectiveness, safety, and efficiency of RF-NL in patients with discogenic LBP. Meta-analyses were perfomed with Revman 5.4. The certainty of evidence was assessed using GRADE Pro.
RESULTS: The SR identified a total of 566 records. After applying all inclusion and exclusion criteria, 8 records were selected. Pooled mean difference (PMD) in pain reduction measured by the Visual Analog Scale was 0.32 points (95% CI: 0.10 to 0.54; I2: 0%). Disability were assessed using different questionnaires o scales, PMD was 0.35 points (95% CI: -0.05 to 0.75; I2: 82%). Regarding safety, the risk difference between RF-NL and comparators was not statistically significant (RD: 0.01; 95% CI: -0.02 to 0.03; I2: 0%). Certainty of the evidence was considered to be moderate to very low, depending on the outcome variable analysed
CONCLUSIONS: RF-NL has not been shown to be inferior to NL performed using other techniques (thermal, laser, ozone, mechanical, or platelet-rich plasma), showing comparable effectiveness and safety outcomes. No evidence has been found regarding the cost-effectiveness of RF-NL compared to other therapeutic alternatives.
Financial disclosure: The study is part of the annual work plan of RedETS, which is led by the Spanish Ministry of Health. Several authors are members of the Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS).
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA122
Topic
Clinical Outcomes, Health Technology Assessment, Medical Technologies
Topic Subcategory
Systems & Structure
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Surgery