Orthopadische Praisklinik, Munich, Germany.
Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
Pain Physician. 2019 Mar;22(2):E111-E118.
BACKGROUND: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. OBJECTIVES: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. STUDY DESIGN: Retrospective chart review. SETTING: This study took place in a single-center, orthopedic specialty hospital. METHODS: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. RESULTS: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). LIMITATIONS: Small retrospective case series. CONCLUSIONS: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. KEY WORDS: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment.
背景:骶髂关节复合体(SIJC)被认为是慢性下腰痛的主要来源。骶髂(SI)关节疼痛的介入治疗往往是短暂的,而手术治疗通常涉及融合手术。
目的:确定经内镜可视射频治疗 SIJC 治疗下腰痛的临床疗效。
研究设计:回顾性图表审查。
设置:本研究在一家单中心骨科专科医院进行。
方法:患者接受全身麻醉,在内窥镜可视化下,对以下部位进行射频消融:1)支配 SI 关节囊后囊的穿支;2)沿长后 SI 韧带走行;3)S1、S2 和 S3 孔的外侧边缘;4)L4、L5 和 S1 内侧缘神经分支沿外侧关节面边缘。
结果:2015 年 1 月至 2016 年 6 月,共有 30 名符合精确纳入标准的患者接受了经内镜 SIJC 射频治疗腰痛。患者平均年龄为 56 岁(19 名女性和 11 名男性),平均术前视觉模拟评分(VAS)为 7.23,平均 Oswestry 残疾指数(ODI)为 44.8。在 3、6、9、12、15、21 和 24 个月时测量 VAS 和 ODI:VAS 从基线时的 7.23 降至 24 个月时的 2.82(降低 61%),ODI 从基线时的 44.8 改善至 24 个月时的 22.2(降低 50%)。
局限性:小回顾性病例系列。
结论:全内镜射频消融大感觉 SI 关节神经支配复合体,包括沿外侧 S1-3 孔的感觉神经分支和 L4-S1 内侧分支,可能是一种微创外科手术,可在精心选择的患者中显著缓解腰椎背痛。
关键词:内镜脊柱外科、微创、下腰痛、骶髂关节、射频治疗。
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