Hashemi Masoud, Hashemian Morteza, Mohajerani Seyed Amir, Sharifi Giv
Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Fereshteh St, Tehran, Iran.
Eur Spine J. 2014 Sep;23(9):1927-32. doi: 10.1007/s00586-014-3412-x. Epub 2014 Jul 6.
Degenerative spondylolisthesis is a well-recognized source of low back pain mainly induced by facet joint pain. Pulsed radiofrequency (PRF) allows heat dissipation, thus producing a temporary injury that affects only type C fibers responsible for pain conduction.
We attempted to test whether PRF is a better choice for facet pain due to spondylolisthesis compared to routine steroid injection.
Patients were randomly assigned to one of two groups: group one received pulsed RF, and group 2 received injection by steroids (triamcinolone) and bupivacaine.
Multiple outcome measures were utilized which included the numeric rating scale (NRS), the Oswestry Disability Index (ODI), satisfaction status, and analgesic intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as reduction of 40% or more.
Eighty patients were enrolled in the study and were divided into the two groups of study. PRF significantly reduced NRS at 6-month follow-up compared to steroid + bupivacaine. 75.6 ± 14.3% at pre-treatment and 19.3 ± 9.5% at 6 months (p = 0.001) in PRF group. The mean ODI is depicted in two groups of study (Fig. 1). Interestingly, ODI% was significantly lower in PRF group at 12 weeks and 6 months compare to steroid + bupivacaine group (p = 0.022 and 0.03, respectively), but it was not significantly different at 6 weeks (p = 0.31). Proportion of patients who did not require analgesics were significantly higher in PRF group compared to other group (p = 0.001) in Log-rank (Mantel-Cox) test.
Our results demonstrated that the application of PRF might be more effective than steroid and bupivacaine injection in decreasing back pain due to degenerative facet pain and improvement in function of patients.
退行性腰椎滑脱是导致下腰痛的一个公认原因，主要由小关节疼痛引起。脉冲射频（PRF）可散热，从而产生仅影响负责疼痛传导的C类纤维的暂时性损伤。
我们试图测试与常规类固醇注射相比，PRF对于因腰椎滑脱引起的小关节疼痛是否是更好的选择。
患者被随机分为两组：一组接受脉冲射频治疗，另一组接受类固醇（曲安奈德）和布比卡因注射。
采用了多种结果测量方法，包括数字评分量表（NRS）、Oswestry功能障碍指数（ODI）、满意度状况以及在治疗后3个月、6个月和12个月时的镇痛药物摄入量评估。显著的疼痛缓解定义为缓解50%或更多，而功能障碍评分的显著改善定义为降低40%或更多。
80名患者参与了该研究并被分为两组。与类固醇+布比卡因相比，PRF在6个月随访时显著降低了NRS。PRF组治疗前为75.6±14.3%，6个月时为19.3±9.5%（p = 0.001）。两组研究中的平均ODI如图1所示。有趣的是，与类固醇+布比卡因组相比，PRF组在12周和6个月时的ODI%显著更低（分别为p = 0.022和0.03），但在6周时无显著差异（p = 0.31）。在对数秩（Mantel-Cox）检验中，PRF组中不需要镇痛药物的患者比例显著高于其他组（p = 0.001）。
我们的结果表明，在减轻因退行性小关节疼痛引起的背痛以及改善患者功能方面，PRF的应用可能比类固醇和布比卡因注射更有效。
