Percutaneous radiofrequency ablation as a treatment for chronic back pain: knowledge, attitude and practices of South African spine surgeons

Abstract

Background: Radiofrequency ablation (RFA) is a well-established treatment for spinal facet joint pain, especially in developed countries. However, several aspects of RFA lack high-quality evidence and the treatment remains contentious. In South Africa, little is known about the perception of RFA or how widely it is utilised. This study investigated the knowledge, attitude and practices of South African spine surgeons concerning the use of RFA to treat chronic axial back pain.

Methods: A survey was conducted at the 2023 South African Spine Society Congress. Spinal orthopaedic surgeons and neurosurgeons were eligible to participate. Responses were presented using descriptive statistics: overall and by subgroups who did and did not practise RFA. Factors associated with conducting RFA were investigated in univariate and multivariate analyses.

Results: Eighty-nine spine surgeons completed the survey, of which 43 (49%) conducted RFA. Full-time private practice had the strongest association with conducting RFA (adjusted risk ratio 2.52, 95% confidence interval [CI] 1.23–5.16). Overall, 62 of 87 (70%) respondents regarded RFA as a good treatment option in certain patients, including 19 of 45 (42%) of respondents who do not conduct the procedure. RFA training was heterogeneous, with course attendance the most common source of training (16 of 41, 39%). RFA practitioners conducted a median of 50 RFAs per year (interquartile range [IQR] 20–80 RFAs per year), although ten practitioners conducted ≥ 100 RFAs per year.

Conclusion: Among the spine surgeons surveyed, there was majority support for the use of RFA in certain patients, and approximately half of respondents conducted the procedure. Findings of potential concern included heterogeneity in RFA training and the observation that a few surgeons conducted particularly high volumes of RFA. Further research should explore whether RFA is used appropriately and effectively in the South African setting by investigating patient selection and technique.

Level of evidence: 3