Cohen Steven P, Hurley Robert W, Buckenmaier Chester C, Kurihara Connie, Morlando Benny, Dragovich Anthony
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21029, USA.
Anesthesiology. 2008 Aug;109(2):279-88. doi: 10.1097/ALN.0b013e31817f4c7c.
Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain.
A randomized placebo-controlled study was conducted in 28 patients with injection-diagnosed sacroiliac joint pain. Fourteen patients received L4-L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation using cooling-probe technology after a local anesthetic block, and 14 patients received the local anesthetic block followed by placebo denervation. Patients who did not respond to placebo injections crossed over and were treated with radiofrequency denervation using conventional technology.
One, 3, and 6 months after the procedure, 11 (79%), 9 (64%), and 8 (57%) radiofrequency-treated patients experienced pain relief of 50% or greater and significant functional improvement. In contrast, only 2 patients (14%) in the placebo group experienced significant improvement at their 1-month follow-up, and none experienced benefit 3 months after the procedure. In the crossover group (n = 11), 7 (64%), 6 (55%), and 4 (36%) experienced improvement 1, 3, and 6 months after the procedure. One year after treatment, only 2 patients (14%) in the treatment group continued to demonstrate persistent pain relief.
These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm these results and to determine the optimal candidates and treatment parameters for this poorly understood disorder.
骶髂关节疼痛是一种具有挑战性的病症，约占慢性下腰痛病例的20%。目前，对于骶髂关节疼痛尚无有效的长期治疗方案。
对28例经注射诊断为骶髂关节疼痛的患者进行了一项随机安慰剂对照研究。14例患者在局部麻醉阻滞之后，使用冷却探头技术对L4 - L5初级背侧支和S1 - S3外侧支进行射频去神经支配，另外14例患者先接受局部麻醉阻滞，随后进行安慰剂去神经支配。对安慰剂注射无反应的患者交叉接受常规技术的射频去神经支配治疗。
术后1个月、3个月和6个月时，接受射频治疗的患者中有11例（79%）、9例（64%）和8例（57%）疼痛缓解达50%或更高，且功能有显著改善。相比之下，安慰剂组仅2例患者（14%）在1个月随访时出现显著改善，术后3个月无患者获益。在交叉组（n = 11）中，术后1个月、3个月和6个月时分别有7例（64%）、6例（55%）和4例（36%）出现改善。治疗1年后，治疗组仅2例患者（14%）持续有疼痛缓解。
这些结果提供了初步证据，表明L4和L5初级背侧支以及S1 - S3外侧支射频去神经支配可能为部分疑似骶髂关节疼痛的患者提供中期疼痛缓解和功能改善。需要开展更大规模的研究来证实这些结果，并确定针对这种了解较少的病症的最佳候选患者和治疗参数。
