Orthopedic Department, the Forth Medical Center of the General Hospital of People's Liberation Army of China, Haidian District, Beijing, China.
Orthopedic Department, the First Affiliated Hospital of Dalian Medical University of China, Dalian, Liaoning Province, China.
World Neurosurg. 2019 Jun;126:e109-e115. doi: 10.1016/j.wneu.2019.01.251. Epub 2019 Feb 18.
To compare the effectiveness of radiofrequency neurotomy (RN) and endoscopic neurotomy (EN) of lumbar medial branch (MB) for facetogenic chronic low back pain (FCLBP).
Forty patients with FCLBP were included and randomly assigned to the control group and the experimental group. The control group (20 cases) underwent X-ray-assisted RN and the experimental group (20 cases) underwent EN of the lumbar MB. The patients' Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score were evaluated and compared preoperatively, and at 3 weeks, 6 months, 1 year, and 2 years postoperatively.
First, the RN group demonstrated successful treatment results (P < 0.05) at 3 weeks, 6 months, and 1 year after surgery. At 2 years, patients reported no significant effectiveness (P > 0.05). Second, the EN group demonstrated more prolonged successful treatment outcomes compared with the RN group. At 2 years, although the efficacy declined further, the VAS and ODI scores showed significant improvements compared with the preoperative data (P < 0.05). Third, there was no difference in VAS and ODI scores between the 2 groups at 3 weeks after surgery (P > 0.05). At 6 months and later, the EN group demonstrated better outcomes (P < 0.05).
For FCLBP, EN and X-ray-assisted RN of lumbar MB are both effective treatments. However, endoscopic lumbar MB neurotomy has the better and longer effectiveness.
比较射频神经切断术（RN）和内镜神经切断术（EN）治疗腰椎内侧支（MB）关节源性慢性下腰痛（FCLBP）的疗效。
纳入 40 例 FCLBP 患者，随机分为对照组和实验组。对照组（20 例）行 X 线辅助 RN，实验组（20 例）行腰椎 MB EN。评估并比较术前、术后 3 周、6 个月、1 年和 2 年患者的视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分。
首先，RN 组术后 3 周、6 个月和 1 年疗效显著（P<0.05），2 年时疗效无显著差异（P>0.05）。其次，EN 组的治疗效果较 RN 组更为持久。2 年时，尽管疗效进一步下降，但 VAS 和 ODI 评分与术前相比仍有显著改善（P<0.05）。第三，术后 3 周时两组 VAS 和 ODI 评分无差异（P>0.05）。6 个月及以后，EN 组的疗效更好（P<0.05）。
对于 FCLBP，EN 和 X 线辅助 RN 治疗腰椎 MB 均有效，但内镜下腰椎 MB 神经切断术效果更好、更持久。
