Lee Cheng-Chia, Chen Ching-Jen, Chou Chien-Chen, Wang Hsin-Yi, Chung Wen-Yuh, Peng Giia-Sheun, Lin Ching-Po
Institute of Brain Research, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Hsin-chu branch, Taipei Veterans General Hospital, Hsin-chu, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
World Neurosurg. 2018 Apr;112:e157-e164. doi: 10.1016/j.wneu.2017.12.183. Epub 2018 Jan 6.
In the study, we discuss the predictive value and cost-effectiveness of dorsal root ganglion (DRG) blocks before using dorsal root ganglion pulsed radiofrequency (DRG-PRF) in the treatment of low back pain.
The study comprised 60 patients with low back pain who were randomly assigned into 2 groups. Patients in group 1 were screened using DRG block before DRG-PRF treatment for responders. Patients in group 2 underwent DRG-PRF treatment without DRG block. Successful outcome was defined as patient satisfaction, improvement in numerical rating scale, and medication use reduction.
In group 1 (n = 30), 24 patients demonstrated good response to DRG block, and 20 patients had successful outcome at 6 months after DRG-PRF therapy. In group 2 (n = 30), 25 of the patients had successful outcome at 6 months after DRG-PRF therapy. The mean medical costs were NT$ 19,245 and NT$ 16,375 for each successful case in groups 1 and 2, respectively.
In this comparative cost-effectiveness study, the application of diagnostic DRG blocks before DRG-PRF did not have a significant impact on patient satisfaction, pain index score, or pain medication reduction. Furthermore, the application of diagnostic DRG blocks resulted in overall greater medical costs. These findings suggest that DRG-PRF without screening by DRG block is more cost-effective and less invasive.
在本研究中，我们探讨在使用背根神经节脉冲射频（DRG-PRF）治疗腰痛之前，背根神经节（DRG）阻滞的预测价值和成本效益。
该研究纳入60例腰痛患者，随机分为2组。第1组患者在进行DRG-PRF治疗前先接受DRG阻滞以筛选出有反应者。第2组患者未进行DRG阻滞直接接受DRG-PRF治疗。成功的结果定义为患者满意度、数字评分量表的改善以及药物使用减少。
在第1组（n = 30）中，24例患者对DRG阻滞表现出良好反应，20例患者在DRG-PRF治疗后6个月取得成功结果。在第2组（n = 30）中，25例患者在DRG-PRF治疗后6个月取得成功结果。第1组和第2组每例成功病例的平均医疗费用分别为新台币19,245元和新台币16,375元。
在这项成本效益比较研究中，在DRG-PRF之前应用诊断性DRG阻滞对患者满意度、疼痛指数评分或疼痛药物减少没有显著影响。此外，应用诊断性DRG阻滞导致总体医疗费用更高。这些发现表明，不通过DRG阻滞进行筛选的DRG-PRF更具成本效益且侵入性更小。
