Smuck Mathew, Crisostomo Ralph A, Demirjian Ryan, Fitch David S, Kennedy David J, Geisser Michael E
Department of Orthopaedic Surgery, Stanford University Spine Center, 450 Broadway St, Redwood City, CA 94063, USA.
Department of Physical Medicine and Rehabilitation, Spine Center, Kaiser Permanente, 975 Sereno Dr, Vallejo, CA 94589, USA.
Spine J. 2015 Jun 1;15(6):1415-21. doi: 10.1016/j.spinee.2013.06.096. Epub 2013 Nov 14.
Medial branch radiofrequency neurotomy (RFN) is a common treatment for zygapophyseal joint pain. The lumbar medial branch innervates these joints and adjacent structures. The impact of the intended neurotomy on these structures remains unclear. No studies have yet verified quantitatively the effect of medial branch RFN on intervertebral discs, facet joints, and multifidus cross-sectional area.
The aim of this study was to determine, using objective radiographic measures, whether there is a quantitative difference in the lumbar multifidus muscle cross-sectional area, facet joint degeneration, or intervertebral disc degeneration after segmental medial branch RFN.
STUDY DESIGN/SETTING: This is a retrospective single-cohort study performed at a university spine center.
The patient sample consisted of 27 patients treated with lumbar medial branch RFN, with pre- and posttreatment magnetic resonance images available for analysis.
The primary study outcome measure was interval change in fat-subtracted multifidus cross-sectional area, and intervertebral disc and zygapophyseal joint degeneration grade.
In this retrospective study, segmental levels unaffected by RFN treatment were used as controls to compare against levels affected by treatment.
Levels affected by RFN demonstrated a significantly greater amount of disc degeneration compared with unaffected levels (14.9% vs. 4.6%; p=.0489). There was no statistical difference in the multifidus cross-sectional area or rates of deterioration in the zygapophyseal joints observed.
The full impact of RFN on multifidus function, morphology, and segmental anatomy is unknown. This retrospective study indicates that measurable changes in segmental morphology may occur after lumbar medial branch RFN. These findings require validation in a prospective, controlled study.
内侧支射频神经切断术（RFN）是治疗关节突关节疼痛的常用方法。腰椎内侧支支配这些关节及相邻结构。预期的神经切断术对这些结构的影响尚不清楚。尚无研究定量验证内侧支RFN对椎间盘、小关节和多裂肌横截面积的影响。
本研究旨在通过客观的影像学测量，确定节段性内侧支RFN术后腰椎多裂肌横截面积、小关节退变或椎间盘退变是否存在定量差异。
研究设计/地点：这是一项在大学脊柱中心进行的回顾性单队列研究。
患者样本包括27例行腰椎内侧支RFN治疗的患者，有治疗前和治疗后的磁共振成像可供分析。
主要研究观察指标为脂肪抑制后多裂肌横截面积、椎间盘和关节突关节退变分级的区间变化。
在这项回顾性研究中，将未受RFN治疗影响的节段水平用作对照，与受治疗影响的节段水平进行比较。
与未受影响的节段相比，受RFN影响的节段椎间盘退变程度明显更高（14.9%对4.6%；p = 0.0489）。观察到的多裂肌横截面积或关节突关节退变率无统计学差异。
RFN对多裂肌功能、形态和节段解剖结构的全面影响尚不清楚。这项回顾性研究表明，腰椎内侧支RFN术后节段形态可能会出现可测量的变化。这些发现需要在前瞻性对照研究中进行验证。
