Efficacy of endoscopic dorsal medial branch radiofrequency ablation combined with manual therapy for chronic lumbar facet joint pain.
Yangming Hu, Yang Liu, Dian Zhong and 2 others
Combining radiofrequency ablation with spinal manipulation gave lower pain and disability scores at 6 months than either alone in 234 patients with chronic facet joint pain.
This was a retrospective comparison, not a randomised trial, so the difference may reflect treatment selection.
Key findings
1At 6 months, the combined RFA plus manual therapy group had a VAS of 3.2 ± 0.6, compared with 3.6 ± 0.8 for RFA alone and 5.6 ± 0.8 for manual therapy alone.
2At 6 months, the combined group had an Oswestry Disability Index of 19.0 ± 2.8, compared with 20.1 ± 2.2 for RFA alone and 26.1 ± 2.5 for manual therapy alone.
3This was a retrospective observational study in which treatment was assigned by clinical decision-making rather than randomisation, and no multivariable or propensity-score adjustment was performed.
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What it does not show
Retrospective and non-randomised: treatment was assigned by clinical decision, not by chance, so the three groups may differ in unmeasured ways (severity, patient preference, clinician bias). No multivariable regression or propensity-score matching was used to adjust for confounders. Single centre, single therapist for all manual therapy sessions, limiting generalisability. Follow-up was only 6 months; published evidence suggests RFA efficacy may diminish after 6–12 months, so the true durability of the combination is unknown. Patients over 60 and those with BMI above 34 were excluded, so the findings may not apply to older or heavier patients. No stratified analysis by age or by specific spinal level was performed.
Declared interests
Funded by the Program for Youth Innovation in Future Medicine, Chongqing Medical University (grant W0021). No industry sponsor, device manufacturer, or treatment vendor is named. The authors declared no other conflicts.
The easy way to misread this
Do not read the lower scores in the combined group as proof that adding manual therapy to radiofrequency ablation is superior. This was a retrospective comparison in which clinicians chose who received which treatment, not a randomised trial, and no statistical adjustment for confounders was made. The combined group may have been selected because they were more motivated, had a different pain pattern, or were seen by a clinician who favoured the combined approach. A randomised trial with 12- to 24-month follow-up is needed before this changes practice.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →