Percutaneous Rhizotomy for Chronic Back or Neck Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

Six systematic reviews, three primary studies and five clinical guidelines were identified for this review. No evidence regarding the cost-effectiveness of percutaneous rhizotomy for adult patients with chronic back or neck pain was identified.Most of the identified systematic reviews concluded the available evidence was of low quality and the benefits appear to be conflicting. Most of the systematic reviews did not pool the data for a summary statistic, making it difficult to know the overall effects for percutaneous rhizotomy. Although two of the identified primary studies, one in patients with ankylosing spondylitis and one in patients with lumbar facetogenic pain, indicated there was a benefit for the procedure, one of these studies was short term (24 weeks) and both were conducted in China. The third identified primary study was conducted in the Netherlands and did not find there were benefits for pain when the procedure was added to physical therapy. The generalizability of these primary studies to the Canadian population may be difficult.The five guidelines also recognized there is limited available data for this procedure and either had weak recommendations or did not recommend percutaneous rhizotomy. One guideline did suggest certain people may benefit from percutaneous rhizotomy but patients must be carefully selected and identified.