射频小关节神经切断术治疗小关节综合征

Radiofrequency facet joint neurotomy in treatment of facet syndrome.

作者信息

Yilmaz Cem, Kabatas Serdar, Cansever Tufan, Gulsen Salih, Coven Ilker, Caner Hakan, Altinors Nur

机构信息

Department of Neurosurgery, Baskent University, Istanbul Hospital, Istanbul, Turkey.

出版信息

J Spinal Disord Tech. 2010 Oct;23(7):480-5. doi: 10.1097/BSD.0b013e3181bf1c76.

DOI:10.1097/BSD.0b013e3181bf1c76

PMID:20124916

Abstract

STUDY DESIGN

Retrospective analyses of 50 patients with lumbar facet syndrome treated with lumbar facet joint neurotomy.

OBJECTIVE

To establish the efficacy of lumbar facet joint neurotomy under optimum conditions in selected patients.

SUMMARY OF BACKGROUND DATA

With the realization of the significance of facet joints in the etiology of chronic low back pain over the last decade, many studies were conducted about various methods of treating the facet joint syndrome.

METHODS

Fifty patients with lumbar facet syndrome with at least 80% pain relief by controlled, diagnostic medial branch blocks underwent lumbar facet joint neurotomy. Before surgery, all were examined carefully both clinically and radiologically and evaluated by visual analog scale (VAS) and descriptive system of health-related quality of life state (EQ5D) measures of pain, disability, and treatment satisfaction. All outcome measures were repeated postoperatively and at 12 months after surgery.

RESULTS

Of the 50 patients 35 were females and 15 were males with a mean age of 51.82±16.99 years. One level was treated in 26 patients, 2 levels in 14, 3 levels in 8, and 4 levels were treated in 2 patients. Symptom duration was ranging between 2 and 24 months with a mean of 7.64±5.98 months. Mean preoperative, postoperative, and at the 12th month VAS were 75.2±11.29, 23.8±10.28, and 24.6±11.817, respectively.Forty-eight percent of patients obtained a relative reduction of at least 70% in VAS, and 86% obtained a reduction of at least 60% at the 12th month. Health-related quality of life state was improved in all patients. When the VAS scores were evaluated with respect to the ages of patients, level numbers, and preoperative symptom duration, no significant differences were found, [0.106, 0.635 and 0.526 (preoperative VAS); 0.033, 0.555, and 0.235 (postoperative VAS); 0.701, 0.978, and 0.155 (follow-up VAS), respectively].

CONCLUSIONS

The most important factors determining success of this procedure is strict patient selection criteria and technique of the procedure.

摘要

研究设计

对50例行腰椎小关节神经切断术治疗的腰椎小关节综合征患者进行回顾性分析。

目的

确定在最佳条件下对选定患者行腰椎小关节神经切断术的疗效。

背景资料总结

随着过去十年间人们认识到小关节在慢性下腰痛病因中的重要性，针对小关节综合征的各种治疗方法开展了许多研究。

方法

50例腰椎小关节综合征患者，经控制性诊断性内侧支阻滞至少缓解80%疼痛后，接受腰椎小关节神经切断术。术前，对所有患者进行仔细的临床和影像学检查，并通过视觉模拟量表（VAS）以及与健康相关的生活质量状态描述系统（EQ5D）对疼痛、功能障碍和治疗满意度进行评估。所有结局指标在术后及术后12个月重复测量。

结果

50例患者中，女性35例，男性15例，平均年龄51.82±16.99岁。26例患者治疗1个节段，14例治疗2个节段，8例治疗3个节段，2例治疗4个节段。症状持续时间为2至24个月，平均7.64±5.98个月。术前、术后及术后12个月的平均VAS分别为75.2±11.29、23.8±10.28和24.6±11.817。48%的患者VAS相对降低至少70%，86%的患者在术后12个月降低至少60%。所有患者与健康相关的生活质量状态均得到改善。当根据患者年龄、节段数和术前症状持续时间评估VAS评分时，未发现显著差异，[分别为0.106、0.635和0.526（术前VAS）；0.033、0.555和0.235（术后VAS）；0.701、0.978和0.155（随访VAS）]。