Lumbar Radiofrequency Ablation (LRFA)- Myths and Facts: A Narrative Review of the Literature

Lumbar radiofrequency ablation (LRFA) is an interventional procedure that utilizes thermal energy to selectively ablate the lumbar medial branch nerves (LMBN) to provide relief from facet-mediated chronic axial low back pain. While LRFA is widely performed, considerable variability exists in its technical execution. This review aims to synthesize the current literature on key device- and procedure-related factors that influence radiofrequency lesioning and to clarify common misconceptions regarding LRFA.

Emerging evidence suggests that several device-related parameters-including cannula and needle size, active tip length, temperature settings, lesioning duration, and needle angulation-affect lesion size and clinical outcomes. However, the impact of adjunctive steroid administration on lesion characteristics and therapeutic efficacy remains inconclusive. Furthermore, while some concerns have been raised regarding the potential for LRFA to accelerate spinal degeneration, definitive evidence is lacking. There is, however, a plausible association between LRFA and multifidus atrophy. The use of motor testing prior to ablation is warranted. Current data support the safety of LRFA in patients with posterior spinal instrumentation and implantable devices. Device- and procedure-specific variables may significantly influence LRFA lesion characteristics and clinical outcomes. While the safety profile of LRFA is generally favorable, potential complications exist, underscoring the need for a nuanced understanding of optimal procedural techniques. Despite its widespread adoption, misconceptions persist regarding optimal approaches, safety considerations, and determinants of efficacy. This review critically evaluates the existing literature to address these controversies and provide an evidence-based perspective on LRFA.