Diagnostic interventions (seven studies, n=1,320 patients reported in text, or 1,420 patients based on table 4)
The prevalence of lumbar facet joint pain ranged from 16% (95% CI 9 to 23) to 41% (95% CI 33 to 49); the overall prevalence was 31% (95% CI 28 to 33; seven studies, eight data sets). False positive rates ranged from 17% (95% CI 10 to 24) to 49% (95% CI 39 to 59); the overall false positive rate was 30% (95% CI 27 to 33; six studies, seven data sets). Each of the seven studies had a quality score of 75.
Therapeutic interventions
Intra-articular facet joint blocks: No randomized controlled trial or observational study of intra-articular facet joint blocks met the inclusion criteria.
Lumbar facet joint nerve blocks (two randomized controlled trials - RCTs, n=204 patients): One RCT assessed the clinical effectiveness of therapeutic local anaesthetic lumbar facet joint nerve blocks with (group II) or without (group I) steroid; it found significant improvement with significant pain relief (50% or more) in 80% of group 1 patients and functional improvement (40% or more) in 85% of group I patients. The second RCT allocated 84 patients with lumbar facet joint mediated pain to receive therapeutic injections with local anaesthetic and sarapin (a natural medicine from the pitcher plant) , or a mixture of local anaesthetic plus sarapin plus methylprednisolone; it found a cumulative significant relief with one to three injections of 100% up to one to three months, 82% for four to six months, 21% for seven to 12 months, and 10% after 12 months, with a mean relief of 6.5 ± 0.76 months and a significant improvement in overall health status. The methodological quality scores of these two studies were 73 and 59.
Radiofrequency neurotomy of lumbar facet nerves (one RCT, n=40 patients; two observational studies, n=15 patients and n=209 patients): The RCT found that patients in the active treatment group showed improvement accompanied by significantly greater improvements in paravertebral tenderness, various movements, quality of life, and use of analgesics, when compared with the placebo group (no data reported). One observational study reported that 87% of 15 patients obtained at least 60% pain relief 12 months after the intervention, with 60% achieving at least 90% relief. The second observational study reported that, of 174 patients with complete data, 55 (31.6%) experienced no benefit from the procedure and 119 (68.4%) had good to excellent pain relief lasting from six to 24 months. The RCT had a methodological quality score of 50. The two observational studies had scores of 73 and 63.