36-Month prospective multicenter randomized controlled trial comparing endoscopic facet denervation and cryoneurolysis for chronic lumbar facet joint pain
In brief
Cryoneurolysis and endoscopic facet denervation give comparable 3-year pain relief
In a 36-month randomized trial of 80 patients with lumbar facet joint pain, both cryoneurolysis and endoscopic facet denervation produced sustained reductions in pain, disability and quality-of-life scores, with no meaningful difference between the groups. Reintervention was needed in 20% versus 30% of patients, a non-significant gap. Larger studies are needed to determine if one technique is truly superior or interchangeable.
- Journal
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Róbert Rapčan, Ladislav Kočan, Viktor Witkovsky, Juraj Mláka, Martin Griger, Ľubomír Poliak, et al.
- PMID
- 42696034
- DOI
- 10.1007/s00586-026-10143-8
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 11 October 2026): 36‑month RCT comparing endoscopic facet denervation vs cryoneurolysis for lumbar
- Picked for Spine Surgery (top studies of the week, 11 October 2026): 36‑month RCT comparing facet denervation vs cryoneurolysis
Abstract
BACKGROUND: Cryoneurolysis and endoscopic facet denervation are established minimally invasive treatment options for lumbar facet joint-mediated pain; however, comparative evidence regarding their long-term effectiveness remains limited. This study compared the 36-month clinical outcomes of both procedures in a prospective multicenter randomized clinical trial. METHODS: Eighty patients with lumbar facet joint-mediated pain confirmed by dual controlled medial branch blocks (≥ 70% pain relief) were randomized to undergo cryoneurolysis (n = 40) or endoscopic facet denervation (n = 40). The primary endpoint was low back pain intensity measured using the Numeric Rating Scale (NRS) at the predefined 36-month follow-up. Secondary outcomes included disability, health-related quality of life, and reintervention rates. Longitudinal mixed-effects modelling and conservative sensitivity analyses were performed. RESULTS: Both treatment groups demonstrated significant and sustained improvements in pain, disability, and health-related quality of life compared with baseline. No statistically significant between-group difference was observed for the primary endpoint at 36 months. Longitudinal mixed-effects modelling demonstrated no significant treatment-by-time interaction (p = 0.74), with an adjusted between-group difference of 0.01 NRS points (95% CI -1.07 to 1.10; p = 0.98). Sensitivity analyses yielded findings consistent with the primary mixed-effects analysis. Reintervention was required in 8 of 40 patients (20.0%) in the cryoneurolysis group and 12 of 40 patients (30.0%) in the endoscopic denervation group (p = 0.44). CONCLUSION: Both cryoneurolysis and endoscopic facet denervation were associated with sustained improvements in pain, disability, and health-related quality of life in carefully selected patients with lumbar facet joint-mediated pain. No statistically significant differences in long-term pain trajectories were observed between treatment groups. Although some secondary analyses numerically favored cryoneurolysis, the study was not designed or powered to establish superiority, equivalence, or non-inferiority between treatment modalities. Larger prospective studies are warranted to confirm these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.