From the Research
The use of saline in lumbar radiofrequency (RF) ablation does not significantly enhance the procedure's efficacy. Current evidence does not support routine saline injection before or during standard lumbar RF ablation procedures. The theoretical benefit of saline injection would be to increase lesion size by improving electrical conductivity and heat distribution around the target nerve, but clinical studies have not consistently demonstrated improved outcomes with this approach.
Key Points to Consider
- Traditional "dry" RF ablation techniques remain the standard of care for lumbar facet denervation procedures 1.
- Some practitioners may use small amounts of saline for specific purposes such as checking electrode impedance or reducing initial tissue resistance, but this differs from deliberate pre-injection of saline to expand lesion size.
- The exception is cooled RF ablation, which uses internally circulating fluid within specialized probes to create larger lesions, but this is a distinct technology from standard RF with saline injection 2.
- Patients undergoing lumbar RF ablation should expect the standard dry technique unless their provider specifically indicates otherwise based on individual clinical circumstances.
Evidence Review
The most recent and highest quality study on this topic is from 2021, which investigated the role of saline concentration during saline-infused radiofrequency ablation 3. However, this study focused on the technical aspects of saline-infused RFA and did not provide direct evidence on the efficacy of saline in lumbar RF ablation.
Other studies, such as the systematic review and meta-analysis from 2020, compared the efficacy of different radiofrequency techniques for treating lumbar facet joint and sacroiliac joint pain, but did not specifically address the use of saline in lumbar RF ablation 2.
Therefore, based on the available evidence, the standard dry technique remains the recommended approach for lumbar RF ablation, unless individual clinical circumstances dictate otherwise.