Effectiveness of thermal radiofrequency ablation versus corticosteroid injections for pain reduction in facet-mediated chronic low back pain: a systematic review and meta-analysis.

Abstract

Background: Facet joint syndrome (FJS) is a prevalent cause of chronic low back pain (CLBP), resulting in reduced quality of life. Radiofrequency ablation (RFA) and corticosteroid injections are commonly utilized; however, direct comparative evidence specific to lumbar FJS remains limited.

Methods: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and Scopus (from inception to November 2025) was conducted to identify randomized controlled trials (RCTs) evaluating thermal RFA versus corticosteroid injections. The primary outcome measured was the Visual Analog Scale (VAS) at 3- and 6-months. Review Manager 5.4 was used to evaluate mean differences (MD) across outcomes using a random-effects model.

Result: Three RCTs with a total of 146 patients were included. Pooled analysis demonstrated significantly greater pain reduction with RFA at both 3-months (MD = -1.27; 95% CI, -1.96 to -0.58; p = 0.0003) and 6-months (MD = -0.86; 95% CI, -1.18 to -0.54; p < 0.00001), favoring RFA. Heterogeneity was moderate to low across timepoints. Although significant, these results fell underneath the minimally important clinical difference (MCID).

Conclusion: In our study, thermal RFA provided greater pain reduction than corticosteroid injections for FJS causing CLBP, suggesting a modest short-term advantage in pain reduction.