Dessouky Riham, Xi Yin, Scott Kelly M, Khaleel Mohammed, Gill Kevin, Jones Stephanie, Khalifa Dalia N, Tantawy Hazim I, Aidaros Magdy A, Chhabra Avneesh
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
World Neurosurg. 2018 Jun;114:e77-e113. doi: 10.1016/j.wneu.2018.02.072. Epub 2018 Mar 23.
BACKGROUND/OBJECTIVE: Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain.
Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model.
A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4-9.2; P = 0.0061).
MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment.
背景/目的：腰背痛和骨盆疼痛是全球最常见的病症之一，会产生重大的社会和经济成本。本研究的目的是评估腰骶丛磁共振神经成像（MRN）在这些慢性疼痛患者的管理及预后中的作用。
纳入连续一年因腰骶部和骨盆慢性疼痛而接受MRN检查的患者。记录成像前和成像后的临床诊断与治疗、疼痛程度及疼痛部位。使用Cox比例风险模型比较不同治疗方法的无痛生存期。
共纳入202例患者，平均年龄53.7±14.8岁，男女比例为1:1.53。其中，115例表现为神经根病（57%），56例为骨盆疼痛（28%），31例为腹股沟疼痛（15%）。平均初始疼痛程度为6.9±1.9。平均症状持续时间为4.21±5.86年。这些患者中，143例（71%）因MRN检查而改变了治疗方案。MRN检查后，32例接受保守治疗的患者中有21例（66%）疼痛程度减轻，67例接受注射治疗的患者中有42例（63%）疼痛减轻，33例接受手术治疗的患者中有27例（82%）疼痛减轻。131例患者接受了随访。无痛生存期的中位数为12个月。在同一时间段内，接受手术治疗的患者疼痛复发率显著低于接受其他治疗的患者（风险比为3.6；95%置信区间为1.4 - 9.2；P = 0.0061）。
在慢性腰骶部和骨盆疼痛中使用MRN可使诊断和治疗发生有意义的改变。MRN检查后，保守治疗和注射治疗可缓解疼痛；然而，患者从手术治疗中获益比从其他任何治疗中更多。
