Schulte T L, Pietilä T A, Heidenreich J, Brock M, Stendel R
Department of Orthopaedics, University Hospital Münster, Münster, Germany.
Acta Neurochir (Wien). 2006 Nov;148(11):1165-72; discussion 1172. doi: 10.1007/s00701-006-0897-z. Epub 2006 Oct 17.
Chronic low back pain remains a major health problem. Facet joint injection therapy is an easy to perform therapeutic option. However, few prospective studies use a standardized protocol to investigate injection therapy. The aim of our study was to evaluate quantity and duration of clinical improvement after this protocol, and to identify the best time for additional repetitive injection therapy.
Thirty-nine patients (21 men, 18 women; mean age 55.2 years [range, 29-87 years]) with lumbar facet syndrome were treated with injection using a standardized protocol (prednisolone acetate, lidocaine 1%, phenol 5%) under fluoroscopic control. Follow-up was based on a specially designed questionnaire. Analysis included MacNab criteria, visual analogue scale, and pain disability index.
Reduction of pain was found up to 6 months after treatment. The outcome was assessed excellent or good by 62% (24 patients) of the patients after 1 month, by 41% (16 patients) after 3 months, and by 36% (14 patients) after 6 months. There was no influence of age, body mass index, or previous lumbar spinal surgery on improvement after treatment. There were no severe side effects. Short-lasting self limiting mild side effects were found in 26% (increased back pain, numbness, heartburn, headache, allergy).
Facet joint injection therapy using a standardized protocol is safe, effective, and easy to perform. The clinical effect is limited, and we recommend repetitive injection according to this protocol after 3 months.
慢性下腰痛仍然是一个主要的健康问题。小关节注射疗法是一种易于实施的治疗选择。然而，很少有前瞻性研究采用标准化方案来研究注射疗法。我们研究的目的是评估该方案治疗后临床改善的程度和持续时间，并确定进行额外重复注射治疗的最佳时机。
39例腰椎小关节综合征患者（21例男性，18例女性；平均年龄55.2岁[范围29 - 87岁]）在透视引导下采用标准化方案（醋酸泼尼松龙、1%利多卡因、5%苯酚）进行注射治疗。随访基于一份专门设计的问卷。分析包括MacNab标准、视觉模拟评分和疼痛残疾指数。
治疗后6个月内疼痛均有减轻。1个月后62%（24例）的患者评估结果为优或良，3个月后为41%（16例），6个月后为36%（14例）。年龄、体重指数或既往腰椎手术史对治疗后的改善情况无影响。未出现严重副作用。26%的患者出现短暂的自限性轻度副作用（背痛加重、麻木、烧心、头痛、过敏）。
采用标准化方案的小关节注射疗法安全、有效且易于实施。临床效果有限，我们建议3个月后根据该方案进行重复注射。
