What is lumbar spine ablation for?

Lumbar Spine Ablation: Purpose and Applications

Lumbar spine ablation is strongly recommended against for chronic axial spine pain (≥3 months) according to the most recent and highest quality evidence, as it has not demonstrated meaningful improvement in patient-important outcomes of morbidity, mortality, and quality of life. 1

What is Lumbar Spine Ablation?

Lumbar radiofrequency ablation (RFA) is an interventional procedure that uses heat to interrupt pain signals by destroying specific nerves in the spine. The procedure involves:

• Using thermal energy to damage targeted nerves that transmit pain signals
• Typically performed under fluoroscopic guidance
• Requires precise needle placement near the targeted nerves
• Usually performed as an outpatient procedure

Types of Lumbar Spine Ablation

Several types of ablation procedures are performed in the lumbar spine:

1. Facet Joint Radiofrequency Ablation

   • Targets the medial branch nerves that supply the facet joints
   • Used for facet joint-mediated pain
   • Performed using multiplanar fluoroscopic visualization 2

2. Sacroiliac Joint Radiofrequency Ablation

   • Targets nerves supplying the sacroiliac joint
   • Used for sacroiliac joint pain

3. Basivertebral Nerve Ablation

   • Targets the basivertebral nerve within vertebral bodies
   • Used for vertebrogenic pain related to degenerative disc disease 3

4. Dorsal Root Ganglion Radiofrequency

   • Targets the dorsal root ganglion
   • Used for radicular pain

Current Evidence and Recommendations

Despite the increasing use of interventional procedures for chronic spine pain, particularly in North America, the 2025 BMJ clinical practice guideline issued strong recommendations against the following procedures for chronic axial spine pain:

• Joint radiofrequency ablation with or without joint-targeted injection
• Epidural injections of local anesthetic, steroids, or their combination
• Joint-targeted injections
• Intramuscular injections 1

For chronic radicular spine pain, the guideline also strongly recommends against dorsal root ganglion radiofrequency and epidural injections.

Conflicting Evidence in the Literature

The evidence regarding the efficacy of RFA for chronic low back pain has been mixed:

• Some older studies suggested RFA might be effective for lumbar facet joint and sacroiliac joint pain 4
• A 2003 study reported 63% of patients had good results at 12-month follow-up 5
• Research on thoracic spine applications is more limited 6
• A study on basivertebral nerve ablation reported improvements in disability scores and pain 3

However, the most recent and comprehensive guideline (2025 BMJ) found that these interventional procedures do not provide clinically meaningful benefits for patient-important outcomes when compared to sham or placebo procedures 1.

Common Pitfalls and Caveats

1. Inconsistent Guidelines: Clinical practice guidelines have provided inconsistent recommendations, with some professional societies strongly recommending these procedures while others recommend against them 1.

2. Author Bias: Positive results for interventional procedures are three times more likely when reviews are authored by interventionalists versus non-interventionalists 1.

3. Limited Long-term Data: Most studies focus on short-term outcomes rather than long-term efficacy.

4. Patient Selection: Proper patient selection is critical but often inadequately addressed in studies.

5. Placebo Effect: The significant placebo effect associated with invasive procedures may confound results.

Alternative Approaches

Given the strong recommendations against interventional procedures for chronic spine pain, clinicians should consider:

• Non-pharmacological approaches (exercise, physical therapy)
• Cognitive behavioral therapy
• Appropriate pharmacological management
• Addressing psychosocial factors contributing to pain

Conclusion

Despite some historical evidence suggesting potential benefits, the most recent and highest quality evidence strongly recommends against lumbar spine ablation procedures for chronic axial and radicular spine pain. The 2025 BMJ guideline, which represents the most comprehensive and methodologically rigorous assessment to date, found that these procedures do not provide clinically meaningful benefits for patient-important outcomes of morbidity, mortality, and quality of life.