Background: Lumbar facet joint (LFJ) pain is the most common cause of low back pain in the elderly. Denervation of the medial branch of the spinal dorsal ramus can theoretically achieve long-term pain relief. Yet there is little evidence of high-level prospective randomized controlled research. Objectives: To observe the effect of radiofrequency (RF) denervation of the medial branch of the spinal dorsal ramus on LFJ pain in the elderly. Study Design: A prospective randomized controlled study. Setting: The study was performed in the National Pain Management and Research Center of China-Japan Friendship Hospital. Methods: A total of 270 patients over 60 years old with LFJ pain were randomly divided into an RF group (n = 135) and a control group (n = 135). They received radiofrequency denervation intervention and a conventional conservative approach, respectively. The follow-up was 6 months. The main outcome was the NRS pain score (0-10 points) and the proportion of patients with a pain reduction of more than 2 points (minimum difference of clinically significant difference). The secondary outcome was the Oswestry Disability Index (ODI), the proportion of patients whose ODI decreased by more than 15 points, and the Macnab standard efficacy evaluation. The factors that influenced the excellent and good Macnab rates were analyzed by univariate and multivariable regression analysis. Results: There were more women than men who suffered from LFJ (171/99) pain based in these 270 patients. The numeric rating scale (NRS) pain score changes in the RF group were significantly different from those in the control group at the 1st, 3rd, and 6th months (-2.3 vs-1.2,-2.0 vs-1.2,-2.0 vs-1.1, P < 0.001), and the proportion of patients whose NRS decreased by >= 2 was higher than that in the control group at the 3rd and 6th months (61.1% vs 26.0%, 52.9% vs 22.5%, P < 0.001). The ODI score changes in the RF group were significantly different from that in the control group at the 1st, 3rd, and 6th months (-15.2 vs-10.1,-14.6 vs-8.6,-13.6 vs-7.7, P < 0.001), and the proportion of ODI reduction >= 15 was also higher than that in the control group at the 3rd and 6th months (45.8% vs 34.1%, 36.4% vs 27.0%, P < 0.05). The excellent rate and efficiency of the Macnab evaluation in the RF group at the 6th month was significantly higher compared to the control group (60.3% vs 36.0%, 81.0% vs 54.1%, P < 0.001). The independent factor affecting the excellent and good rate is failed back surgery syndrome. Limitation: The limitation of this study is that it was only performed in one unit of the National Pain Management and Research Center. It needs to be further carried on in multiple centers in the future. Conclusions: Radiofrequency denervation can effectively reduce LFJ pain and improve movement disorder. The effect is good until 6 months later.