Centers of Rehabilitation and Pain Medicine, Placentia, CA.
The Orthopedic Clinic Association, Phoenix, AZ.
Pain Physician. 2018 Nov;21(6):E661-E665.
There is a paucity of literature studying therapeutic intraarticular zygapophyseal (commonly referred to as facet) joint injections in the atraumatic patient population. As a result of this, intraarticular injections have been dismissed as a possible treatment for cervical zygapophyseal joint-mediated pain. Radiofrequency neurotomy (RFN) is currently the accepted treatment for facet joint neck pain.
This prospective observational study investigated injection response in an atraumatic population to determine treatment viability and whether injections reduce the need for RFN in neck pain patients.
Observational case series study.
This study took place in the outpatient clinic of a private practice.
The double-block paradigm (DBP) was used to determine if symptoms were zygapophyseal joint-mediated. Lidocaine and bupivacaine diagnostic injections were used. Participants passing the DBP underwent fluoroscopically-guided cervical zygapophyseal joint injections (betamethasone and 1% lidocaine) and 1 year of follow-up. Outcomes were a Verbal Numeric Scale score (VNS) > 2, 50% decrease in VNS, patient-reported improvement, and opioid use at the 1-year follow-up.
One hundred and eighteen patients were enrolled; 51 passed the DBP. These 51 patients underwent injections. Forty-four patients (59 joints) were surveyed 1 year later with 7 follow-up losses. Thirty-four of 59 joints showed ≥2-point VNS reductions or ≥ 50% overall symptomatic improvement after 1 year. Twenty-four of 44 ceased narcotics use.
The limitations of this research included the lack of randomization and blinding, smaller sample size, and reliance on subjective reporting from the participants both immediately after the procedures and at follow-up. As this was a prospective observational study, there is the possibility of unintended bias by both patients as well as the authors.
Cervical zygapophyseal joint injections may reduce the need for RFN; additional studies are required.
Neck pain, facet joint, cervical zygapophyseal joint injections, radiofrequency neurotomy.
在非创伤性患者群体中，研究治疗性关节内关节突关节（通常称为关节突关节）注射的文献很少。因此，关节内注射已被排除为治疗颈椎关节突关节介导性疼痛的一种可能方法。射频神经切断术（RFN）目前是治疗关节突关节颈部疼痛的公认方法。
本前瞻性观察性研究调查了非创伤性人群的注射反应，以确定治疗的可行性，以及注射是否减少了 RFN 在颈部疼痛患者中的需求。
观察性病例系列研究。
本研究在一家私人诊所的门诊进行。
采用双阻断范式（DBP）确定症状是否为关节突关节介导的。使用利多卡因和布比卡因诊断性注射。通过 DBP 的参与者接受了荧光引导下的颈椎关节突关节注射（倍他米松和 1%利多卡因）和 1 年的随访。结果是 1 年随访时的数字评分量表（VNS）>2，VNS 降低 50%，患者报告的改善和阿片类药物的使用。
共纳入 118 例患者，其中 51 例通过 DBP。这 51 例患者接受了注射。44 例（59 个关节）在 1 年后接受了调查，随访丢失 7 例。34 个/59 个关节在 1 年后显示 VNS 降低≥2 分或总症状改善≥50%。24/44 例患者停止使用阿片类药物。
本研究的局限性包括缺乏随机化和盲法、样本量较小以及依赖于参与者在手术前后的主观报告。由于这是一项前瞻性观察性研究，患者和作者都有可能出现意外偏倚。
颈椎关节突关节注射可能减少 RFN 的需求；需要进一步研究。
颈部疼痛、关节突关节、颈椎关节突关节注射、射频神经切断术。
