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Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. [Radiofrequency denervation of the spine and the sacroiliac joint : A systematic literature search according to GRADE with new German S3 guideline]. Schmerz 2024:10.1007/s00482-024-00799-w. [PMID: 38427035 DOI: 10.1007/s00482-024-00799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This article summarizes the results of the German guideline on radiofrequency denervation of the facet joints and the sacroiliac joint. Evidence on the indications, test blocks and technical parameters are presented. OBJECTIVE The aim is to avoid overtreatment and undertreatment, which is also of socioeconomic importance. MATERIAL AND METHOD A systematic evaluation of the literature was carried out according to the grading of recommendations assessment, development and evaluation (GRADE) approach. A multidisciplinary guideline group has developed recommendations and statements. RESULTS Statements and recommendations were given for 20 key questions. There was an 87.5% consensus for 1 recommendation and 100% consensus for all other recommendations and statements. The guideline was approved by all scientific medical societies involved. Specific questions included the value of the medical history, examination and imaging, the need for conservative treatment prior to an intervention, the importance of test blocks (medial branch block and lateral branch block), choice of imaging for denervation, choice of trajectory, the possibility to influence the size of the lesion, stimulation, the possibility of revision, sedation and decision support for patients with anticoagulants, metal implants and pacemakers and advice on how to avoid complications. CONCLUSION Selected patients can benefit from well-performed radiofrequency denervation. The guideline recommendations are based on very low to moderate quality of evidence.
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Affiliation(s)
- Stephan Klessinger
- Neurochirurgie Biberach, Eichendorffweg 5, 88400, Biberach, Deutschland.
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | | | - Sebastian Gillner
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Sana Krankenhaus Benrath, Gräulicher Str. 120, 40625, Düsseldorf, Deutschland
| | - Holger Koepp
- Wirbelsäulenzentrum, St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Deutschland
| | - Andreas Kopf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - Martin Legat
- Schmerzzentrum Zofingen, Hintere Hauptgasse 9, 4800, Zofingen, Schweiz
| | - Katharina Meiler
- Orthopädie, Städtisches Klinikum Magdeburg, Birkenallee 34, 39130, Magdeburg, Deutschland
| | - Heike Norda
- UVSD SchmerzLOS e. V., Fürsthof 24, 24534, Neumünster, Deutschland
| | | | - Matti Scholz
- ATOS Orthopädische Klinik Braunfels GmbH & Co. KG, Hasselbornring 5, 35619, Braunfels, Deutschland
| | - Phillipp J Slotty
- Klinik für Neurochirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Volker Tronnier
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Martin Vazan
- Praxis für Neurochirurgie, Wirbelsäulen- und Rückenzentrum Dresden, Borsbergstr. 44, 01309, Dresden, Deutschland
| | - Karsten Wiechert
- Rückenzentrum am Michel, Ludwig-Erhard-Str. 18, 20459, Hamburg, Deutschland
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