Intraarticular Steroids Versus Radiofrequency Denervation of Lumbar Facets for Treatment of Low Back Pain
Bibliographic record
Abstract
To the Editor A recent article by Lakemeier et al.1 concluded that both infiltrating steroids into lower lumbar facet joints and radiofrequency (RF) denervation of these joints were similarly effective in improving functional ability and reducing pain. However, I have several questions regarding the methodology and conclusions of this article. First, the authors state that a 20-G RF cannula was used to inject steroid into the lumbar facet joints. However, a 22- or a 25-G needle is usually recommended to access these joints as is confirmation of needle placement by injecting fluoroscopic contrast.2 The joint cavity is fairly narrow and accessing it using a 20-G cannula is a difficult proposition. How, in other words, did the authors confirm intraarticular injections in the subjects recruited in the steroid group? This is important because extra-articular deposition of steroids can be associated with systemic absorption resulting in decreased levels of proinflammatory cytokines and analgesia.3 Second, the authors comment “patients in the trial were taking a multitude of different nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in different dosages, and they were not of comparable active ingredient content, especially the opioids.” Why then was average daily opioid intake in their participants not converted into oral morphine equivalent doses? This would have facilitated a determination of the effect of either treatment on opioid use. Third, and regarding data analysis, the authors state, “the probability for an improvement from the RF denervation group would be higher than an improvement from the other group is equal to 0.5,” but they offer no explanation for this adjustment. Finally, long-term analgesic and functional outcomes (perhaps at 1 year after the interventions) should be provided because published trials suggest that RF denervation may result in sustained benefits.4,5 Anuj Bhatia, MBBS, MD, FRCA, FRCPC, FIPP, FFPMRCA, EDRA Department of Anesthesia and Pain Management Toronto Toronto Western Hospital University Health Network Mount Sinai Hospital, and Women’s College Hospital University of Toronto Toronto Ontario, Canada [email protected]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.010 | 0.015 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".