News & Press: Advocacy

SIS Reviewing Significantly Flawed Dutch Neurotomy Study

Monday, July 10, 2017  

Members of the Spine Intervention Society’s Standards Division have identified significant shortcomings with patient selection and technique used in a recent lumbar radiofrequency neurotomy study out of the Netherlands by Juch et al. The study derives erroneous conclusions about the effectiveness of lumbar radiofrequency neurotomy and unfortunately some insurers may try to use it to limit coverage, relegating patients to continued suffering and/or dependence on opioids.

Inherent Bias Potential
Because this unblinded study was funded in part by grant money received from Dutch health insurance companies, SIS is concerned about the potential risk of bias arising from this possible conflict of interest.

Inadequate Diagnostic Assessment
The study selected patients for radiofrequency neurotomy (RFN) based on inadequate diagnostic assessment. For that reason, many patients treated with RFN likely did not have facet joint or sacroiliac joint pain, and would not have been expected to experience pain relief or functional improvement.

Ineffective Technique Selection
The lumbar medial branch radiofrequency neurotomy technique employed in the Juch study used a small gauge (22G) electrode with positioning inconsistent with the “parallel technique” as described in the SIS Guidelines, wherein large gauge radiofrequency electrodes have been established as effective in providing pain relief for patients with lumbar facet joint pain. The small lesions employed in the Dutch study most likely missed many of the targeted nerves and would not be expected to relieve pain from the lumbar facet joints.

The Society is currently preparing a formal response and hopes to see it published in the Journal of the American Medical Association.

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