Department of Anesthesia and Critical Care, MGH Center for Pain Medicine, Boston, MA 02114, USA.
Clin J Pain. 2010 Feb;26(2):110-5. doi: 10.1097/AJP.0b013e3181b8cd4d.
To determine the correlation between magnetic resonance imaging (MRI) pathology and the response to diagnostic facet medial branch block (MBB) and L5 dorsal ramus medial branch block and radiofrequency (RF) denervation of lumbar facet joints.
The medical records of 127 consecutive patients who underwent MBB for suspected zygapophysial joint pain were reviewed. The lumbar spine MRI of these patients was systematically graded by 2 musculoskeletal radiologists for loss of disc height, spinal stenosis, facet joint degeneration, and other forms of spinal pathology.
Patients with central or foraminal spinal stenosis had statistically significant correlation with positive outcome of RF (P=0.02), but not with MBB (P=0.08). The presence of facet joint degeneration or hypertrophy was positively correlated with response to MBB (71% vs. 51%; P=0.04), but not RF. Loss of disc height did not correlate with outcome of MBB (P=0.08) and RF (P=0.29). For other spinal pathology, no significant differences were noted for either the response to diagnostic blocks or the RF denervation. Younger patients were more likely to fail MBB (P<0.01) but not RF denervation (P=0.38).
Whereas some relationships were noted between MRI findings and the response to lumbar facet joint interventions, many of these correlations tended to be weak. However, this study does suggest the possibility that patients with spinal stenosis, often considered an exclusion criterion for facet interventions, may respond to RF denervation of facet joints. Prospective studies are needed to confirm these observations.
确定磁共振成像（MRI）病理学与诊断性关节突内侧支阻滞（MBB）和 L5 背侧干内侧支阻滞以及腰椎关节突关节射频（RF）去神经支配反应之间的相关性。
回顾了 127 例连续接受 MBB 治疗疑似关节突关节疼痛的患者的病历。由 2 名肌肉骨骼放射科医生对这些患者的腰椎 MRI 进行系统分级，以评估椎间盘高度丧失、椎管狭窄、关节突关节退变和其他形式的脊柱病变。
中央或椎间孔椎管狭窄的患者与 RF 阳性结果具有统计学显著相关性（P=0.02），但与 MBB 无相关性（P=0.08）。关节突关节退变或肥大的存在与 MBB 的反应呈正相关（71%对 51%；P=0.04），但与 RF 无关。椎间盘高度丧失与 MBB （P=0.08）和 RF （P=0.29）的反应均无相关性。对于其他脊柱病变，无论是对诊断性阻滞的反应还是对 RF 去神经支配的反应，都没有显著差异。年轻患者更有可能对 MBB （P<0.01）失败，但对 RF 去神经支配（P=0.38）无影响。
尽管 MRI 发现与腰椎关节突关节干预反应之间存在一些相关性，但这些相关性大多较弱。然而，本研究确实表明，椎管狭窄的患者（通常被认为是关节突介入的排除标准）可能对关节突关节的 RF 去神经支配有反应。需要前瞻性研究来证实这些观察结果。
