Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis
Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis
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DOI：
10.1016/j.spinee.2007.04.022
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发表时间：
2008-05-01
期刊：
影响因子：
4.5
通讯作者：
Hurley, Robert W.
中科院分区：
文献类型：
--
作者：
Cohen, Steven P.;Stojanovic, Milan P.;Hurley, Robert W.
背景情况：最近发表的几项研究表明，射频（RF）腰椎关节突（1-z）关节去神经支配的益处甚微，这促使许多研究人员重新评估选择标准。对这些发现的一个有争议的解释是，选择1-z（小关节）关节RF去神经支配患者的最常用截止值（诊断性阻滞后疼痛缓解大于50%）太低，因此导致高失败率。比较传统器械与大于或等于50%的器械之间的1-z关节RF去神经成功率疼痛缓解阈值和更严格地建议大于或等于诊断性内侧分支传导阻滞（MBB）的80%临界值。研究设计/设置：多中心、回顾性临床数据分析。患者样本：262名慢性腰痛患者在三家疼痛诊所接受了1-z RF去神经治疗。结果指标是基于视觉模拟量表或射频去神经术后持续至少6个月的数字疼痛评级评分的疼痛缓解大于50%，以及整体感知效应（GPE），其中考虑了疼痛缓解，满意度和功能改善。在三个中心收集了262名患者的数据，这些患者在诊断性MBB后获得大于或等于50%的疼痛缓解后接受1-z RF去神经支配。受试者分为接受MBB部分（大于或等于50%但小于80%）和接近完全（大于或等于80%）疼痛缓解的受试者。控制14个人口统计学和临床变量后，组间的结果进行了比较与多变量分析。结果：145例患者获得大于或等于50%，但小于80%的诊断MBB后疼痛缓解，117例患者获得大于或等于80%的缓解。在大于或等于50%组中，基于疼痛缓解和GPE的成功率分别为52%和67%。在经历了大于80%的缓解诊断块的患者中，56%获得大于或等于50%的缓解RF去神经支配和66%有一个积极的GPE.CONCLUSIONS：使用更严格的疼痛缓解标准时，选择患者1-Z联合RF去神经支配是不太可能提高成功率，并可能导致误诊和扣留潜在的有价值的治疗良好的候选人。(C)2008年爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: The publication of several recent studies showing minimal benefit for radiofrequency (RF) lumbar zygapophysial (1-z) joint denervation have led many investigators to reevaluate selection criteria. One controversial explanation for these findings is that the most commonly used cutoff value for selecting patients for 1-z (facet) joint RF denervation, greater than 50% pain relief after diagnostic blocks, is too low and hence responsible for the high failure rate.PURPOSE: To compare 1-z joint RF denervation success rates between the conventional greater than or equal to 50% pain relief threshold and the more stringently proposed greater than or equal to 80% cutoff for diagnostic medial branch blocks (MBB).STUDY DESIGN/SETTING: Multicenter, retrospective clinical data analysis.PATIENT SAMPLE: Two hundred and sixty-two patients with chronic low back pain who underwent 1-z RF denervation at three pain clinics.OUTCOME MEASURES: Outcome measures were greater than 50% pain relief based on visual analog scale or numerical pain rating score after RF denervation persisting at least 6 months post-procedure, and global perceived effect (GPE), which considered pain relief, satisfaction and functional improvement.METHODS: Data were garnered at three centers on 262 patients who underwent 1-z RF denervation after obtaining greater than or equal to 50% pain relief after diagnostic MBB. Subjects were separated into those who received partial (greater than or equal to 50% but less than 80%) and near-complete (greater than or equal to 80%) pain relief from the MBB. Outcomes between groups were compared with multivariate analysis after controlling for 14 demographic and clinical variables.RESULTS: One hundred and forty-five patients obtained greater than or equal to 50% but less than 80% pain relief after diagnostic MBB, and 117 patients obtained greater than or equal to 80% relief. In the greater than or equal to 50% group, success rates were 52% and 67% based on pain relief and GPE, respectively. Among patients who experienced greater than 80% relief from diagnostic blocks, 56% obtained greater than or equal to 50% relief from RF denervation and 66% had a positive GPE.CONCLUSIONS: Using more stringent pain relief criteria when selecting patients for 1-z joint RF denervation is unlikely to improve success rates, and may lead to misdiagnosis and withholding a potentially valuable treatment from good candidates. (C) 2008 Elsevier Inc. All rights reserved.