Boswell Mark V, Manchikanti Laxmaiah, Kaye Alan D, Bakshi Sanjay, Gharibo Christopher G, Gupta Sanjeeva, Jha Sachin Sunny, Nampiaparampil Devi E, Simopoulos Thomas T, Hirsch Joshua A
Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; LSU Health Science Center, New Orleans, LA; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Manhattan Spine an.
Pain Physician. 2015 Jul-Aug;18(4):E497-533.
Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain.
A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks.
To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain.
A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles.
Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements.
The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II with 80% or higher pain relief as the criterion standard with a prevalence ranging from 34% to 48% and false-positive rates ranging from 42% to 48%.
The shortcomings of this systematic review include a paucity of literature related to the thoracic spine, continued debate on an appropriate gold standard, appropriateness of diagnostic blocks, and utility.
The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks, Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks in assessment of chronic spinal pain.
脊柱关节突关节，即小关节，是脊柱轴向疼痛及四肢牵涉痛的一个来源。传统的临床特征及其他非侵入性诊断方法在诊断关节突关节疼痛方面并不可靠。
对脊柱小关节神经阻滞诊断准确性的系统评价。
确定脊柱小关节神经阻滞在慢性脊柱疼痛中的诊断准确性。
采用可靠性研究质量评估（QAREL）对纳入研究进行方法学质量评估。仅纳入至少符合50%指定纳入标准的诊断准确性研究用于分析。根据最佳证据综合的证据分级，证据水平分为I级至V级。数据来源包括通过检索1966年至2015年3月发表的PubMed及其他电子数据库、Cochrane综述以及对已知的原始文献和综述文章的参考文献进行手工检索所确定的相关文献。
研究必须采用局部麻醉药对照阻滞。标准参照必须是与基线评分相比疼痛缓解至少5%，且能够完成之前疼痛的动作。
对于腰椎小关节神经阻滞，现有证据为I级，共纳入17项双诊断阻滞研究，疼痛缓解至少75%，平均患病率为16%至41%，假阳性率为25%至44%。对于颈椎小关节神经阻滞诊断颈椎小关节疼痛的证据为II级，基于11项对照诊断准确性研究，在异质性人群中患病率差异较大且存在内部不一致性。患病率范围为36%至67%，以疼痛缓解至少80%作为标准参照，假阳性率为27%至63%。对于胸椎小关节神经阻滞诊断准确性的证据为II级，以疼痛缓解80%或更高作为标准参照，患病率范围为34%至48%，假阳性率范围为42%至48%。
本系统评价的缺点包括与胸椎相关的文献较少、关于合适的金标准、诊断阻滞的适宜性及实用性仍存在争议。
在评估慢性脊柱疼痛时，腰椎小关节神经阻滞诊断准确性的证据为I级，颈椎小关节神经阻滞为II级，胸椎小关节神经阻滞为II级。
