Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain
Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain
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DOI：
10.1097/00007632-200005150-00012
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发表时间：
2000-05-15
期刊：
影响因子：
3
通讯作者：
Joshi, A
中科院分区：
文献类型：
--
作者：
Dreyfuss, P;Halbrook, B;Joshi, A
研究设计。前瞻性审计。目的探讨在最佳条件下腰椎内支神经切断术的疗效。背景资料摘要。先前关于腰椎内侧支神经切开术疗效的报道，由于患者选择不当、手术技术不准确和结果评估不充分而引起混淆。对15例慢性腰痛患者行腰椎内侧支神经切开术，治疗后疼痛得到缓解。在手术前，通过视觉模拟量表和各种有效的疼痛、残疾和治疗满意度测量来评估所有患者。术前和术后均行多裂肌肌电图检查，以确保神经切开术的准确性。在术后6周、3个月、6个月和12个月重复所有结果测量。结果：约60%的患者在12个月时疼痛缓解至少90%，87%的患者疼痛缓解至少60%。缓解与多裂肌内侧分支已凝固的那些节段的去神经支配有关。损伤前电刺激内侧支神经并测量阻抗与结果无关。腰椎内侧支神经切开术是一种有效的减轻疼痛的方法，是在控制诊断块的基础上精心选择的患者。通过仔细地将电极放置在放射学判断的正确位置，可以实现目标神经的充分凝固。损伤前的电刺激对于确保电极的正确放置是多余的。
Study Design. A prospective audit.Objective. To establish the efficacy of lumbar medial branch neurotomy under optimum conditions.Summary of Background Data. Previous reports of the efficacy of lumbar medial branch neurotomy have been confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome.Methods. Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the lumbar zygapophysial joints, underwent lumbar medial branch neurotomy. Before surgery, all were evaluated by visual analog scale and a variety of validated measures of pain, disability, and treatment satisfaction. Electromyography of the multifidus muscle was performed before and after surgery to ensure accuracy of the neurotomy. All outcome measures were repeated at 6 weeks, and 3, 6, and 12 months after surgery.Results: Some 60% of the patients obtained at least 90% relief of pain at 12 months, and 87% obtained at least 60% relief. Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated. Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome.Conclusions. Lumbar medial branch neurotomy is an effective means of reducing pain in patients carefully selected on the basis of controlled diagnostic blocks. Adequate coagulation of the target nerves can be achieved by carefully placing the electrode in correct position as judged radiologically. Electrical stimulation before lesioning is superfluous in assuring correct placement of the electrode.