Comparative Effectiveness of Radiofrequency Ablation, Cryoablation, and Endoscopic Denervation for Lumbar Facet Pain

Study design. Multicenter, prospective, randomized trial. Trial Registration: ClinicalTrials.gov Identifier: NCT05813639 Background. Lumbar facet joint syndrome is a common cause of chronic low back pain, often resistant to conservative treatment. Interventional options such as radiofrequency ablation (RF), cryoablation (Cry), and endoscopic facet denervation (ED) are increasingly used, yet head-to-head comparisons are limited. Objective. To compare the long-term clinical effectiveness of RFA, Cry, and ED in patients with confirmed facet-mediated low back pain. Methods. 62 patients with chronic lumbar back pain and ≥70% relief after controlled diagnostic medial branch blocks were randomized to receive RFA (n=19), Cry (n=23), or ED (n=20). Primary outcomes included changes in back and leg pain intensity (Numeric Rating Scale) and functional disability (Oswestry Disability Index) at 3, 6, 12, and 24 months post-intervention. Results. All three treatment groups showed significant and sustained improvements in back pain and functional status over the two-year follow-up. RFA provided the most consistent long-term relief. Cry showed comparable early and mid-term efficacy, though leg pain relief diminished by 24 months. ED achieved rapid early improvement in back pain, but had limited and less durable effects on referred leg pain. No statistically significant differences were observed between groups in any of the outcome measures. Conclusions. RF, Cry, and ED are all effective and safe treatment modalities for lumbar facet joint syndrome. While RF remains the most established option, Cry and ED may be considered viable alternatives in appropriately selected patients. Treatment should be tailored based on clinical context, patient preferences, and available resources. Further large-scale studies are needed to refine patient selection and optimize outcomes.