Park Ji-Hoon, Jang Jae Ni, Park Soyoon, Choi Young-Soon, Ryu Dae Kyun, Miah Rakib, Park Sukhee
Department of Anesthesiology and Pain Medicine, Keimyung University College of Medicine, Daegu, Korea (the Republic of).
Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Korea (the Republic of).
Reg Anesth Pain Med. 2025 Jul 24. doi: 10.1136/rapm-2025-106723.
Lumbar radicular pain (LRP) and/or lower back pain is a challenging condition, particularly in cases refractory to conservative treatments like epidural steroid injections (ESI). Pulsed radiofrequency (PRF) to the dorsal root ganglion and epidural neuroplasty techniques are emerging as alternative interventional treatments. However, there are no direct comparison studies between PRF and epidural neuroplasty, leading to uncertainty in optimal treatment selection.
This network meta-analysis (NMA) aims to indirectly compare the efficacy of PRF and epidural neuroplasty techniques in managing LRP.
We conducted a systematic review and NMA of randomized controlled trials (RCTs) comparing PRF, epidural neuroplasty, and conservative treatments, including ESI and sham procedures. Data sources included PubMed, Cochrane Central, Embase, and Web of Science up to December 31, 2024. Inclusion criteria comprised RCTs evaluating adult patients with lumbar radicular pain from disc herniation, spinal stenosis, or failed back surgery syndrome. Two reviewers independently extracted data on study design, interventions, outcomes, and risk of bias. The primary outcome was pain reduction at 1, 3, 6, and 12 months post-treatment. The secondary outcome was disability reduction, measured by the Oswestry Disability Index (ODI). A frequentist random-effects model was used for data synthesis, and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Prediction intervals were not calculated due to data limitations, which is acknowledged as a limitation.
14 RCTs comprising 1229 patients were included. At 1 month, there was no significant difference between PRF and epidural neuroplasty. At 3 months, epidural neuroplasty showed significant advantages over PRF (mean difference: -1.47, 95% CI -2.73 to -0.46); however, the certainty of evidence for this comparison was rated low. Similar trends were observed at 6 and 12 months, but the confidence in these estimates remained low to very low. For ODI, no significant differences were found at time points, and the certainty of evidence was moderate to very low across comparisons.
PRF and epidural neuroplasty may offer comparable long-term pain and disability outcomes for patients with lumbar radicular pain, but the overall certainty of evidence was low to very low, limiting confident clinical recommendations. These findings highlight the need for high-quality, head-to-head trials to better inform interventional treatment strategies for LRP.
腰椎神经根性疼痛（LRP）和/或下背痛是一种具有挑战性的病症，尤其是在对硬膜外类固醇注射（ESI）等保守治疗无效的情况下。背根神经节脉冲射频（PRF）和硬膜外神经成形术技术正在成为替代介入治疗方法。然而，PRF和硬膜外神经成形术之间尚无直接比较研究，这导致在最佳治疗选择上存在不确定性。
本网络荟萃分析（NMA）旨在间接比较PRF和硬膜外神经成形术技术在治疗LRP中的疗效。
我们对比较PRF、硬膜外神经成形术和保守治疗（包括ESI和假手术）的随机对照试验（RCT）进行了系统综述和NMA。数据来源包括截至2024年12月31日的PubMed、Cochrane Central、Embase和Web of Science。纳入标准包括评估因椎间盘突出、椎管狭窄或腰椎手术失败综合征导致腰椎神经根性疼痛的成年患者的RCT。两名 reviewers 独立提取有关研究设计、干预措施、结局和偏倚风险的数据。主要结局是治疗后1、3、6和12个月时的疼痛减轻。次要结局是通过Oswestry功能障碍指数（ODI）衡量的功能障碍减轻。采用频率学派随机效应模型进行数据合成，并使用推荐分级、评估、制定和评价方法评估证据的确定性。由于数据限制未计算预测区间，这被视为一项局限性。
纳入了14项RCT，共1229例患者。在1个月时，PRF和硬膜外神经成形术之间无显著差异。在3个月时，硬膜外神经成形术显示出优于PRF的显著优势（平均差值：-1.47，95% CI -2.73至-0.46）；然而，该比较的证据确定性被评为低。在6个月和12个月时观察到类似趋势，但对这些估计值的置信度仍然很低至非常低。对于ODI，在各时间点均未发现显著差异，且各比较中证据的确定性为中等至非常低。
PRF和硬膜外神经成形术可能为腰椎神经根性疼痛患者提供相当的长期疼痛和功能障碍结局，但证据的总体确定性很低至非常低，限制了可靠的临床推荐。这些发现凸显了开展高质量、直接比较试验以更好地为LRP介入治疗策略提供信息的必要性。
