Burnham Taylor, Conger Aaron, Salazar Fabio, Petersen Russell, Kendall Richard, Cunningham Shellie, Teramoto Masaru, McCormick Zachary L
Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA.
Pain Med. 2020 Oct 1;21(10):2071-2076. doi: 10.1093/pm/pnz358.
Cervical medial branch radiofrequency ablation (CMBRFA) is an effective treatment for facetogenic pain in patients selected by Spine Intervention Society (SIS) guidelines of 100% symptom improvement with dual medial branch blocks (MBBs) ± placebo block. Patient selection for CMBRFA using ≥80% symptom improvement after dual concordant MBBs is common; however, this has not been studied.
To evaluate the effectiveness of CMBRFA and compare outcomes in individuals selected by 80-99% vs 100% symptom improvement with dual concordant MBBs.
Cross-sectional cohort study.
Medical records of 87 consecutive patients were reviewed; 50 met inclusion criteria. A standardized telephone survey was performed at six or more months post-CMBRFA to query numerical rating scale (NRS) pain and patient global impression of change (PGIC) scores. The primary outcomes were the proportion of patients reporting ≥50% reduction of index pain.
At a mean follow-up time of 16.9 ± 12.7 months, 54% (95% confidence interval [CI] = 35-73%) and 54% (95% CI = 32-74%) of the 80-99% and 100% MBBs groups, respectively, reported ≥50% pain reduction. Between-group comparison showed a relative risk of 0.99 (95% CI = 0.59-1.66) for meeting the primary outcome. Seventy percent (95% CI = 56-81%) of patients reported a PGIC score consistent with "improved or very much improved" at follow-up.
CMBRFA is an effective treatment in patients who report ≥80% symptom relief with dual concordant MBBs. The present study demonstrated an overall ≥50% pain reduction rate of 54% and no significant difference between those selected by 80-99% vs 100% symptom relief with dual concordant MBBs.
根据脊柱介入协会（SIS）指南，经双内侧支阻滞（MBB）±安慰剂阻滞症状改善100%的患者，颈椎内侧支射频消融术（CMBRFA）是治疗小关节源性疼痛的有效方法。使用双一致MBB后症状改善≥80%来选择CMBRFA治疗的患者很常见；然而，尚未对此进行研究。
评估CMBRFA的有效性，并比较双一致MBB症状改善80 - 99%与100%的患者的治疗结果。
横断面队列研究。
回顾了87例连续患者的病历；50例符合纳入标准。在CMBRFA术后6个月或更长时间进行标准化电话调查，询问数字评分量表（NRS）疼痛评分和患者总体变化印象（PGIC）评分。主要结局是报告指数疼痛减轻≥50%的患者比例。
平均随访时间为16.9±12.7个月，80 - 99%和100% MBB组分别有54%（95%置信区间[CI]=35 - 73%）和54%（95% CI = 32 - 74%）的患者报告疼痛减轻≥50%。组间比较显示达到主要结局的相对风险为0.99（95% CI = 0.59 - 1.66）。70%（95% CI = 56 - 81%）的患者在随访时报告PGIC评分符合“改善或显著改善”。
对于双一致MBB症状缓解≥80%的患者，CMBRFA是一种有效的治疗方法。本研究表明总体疼痛减轻≥50%的比例为54%，双一致MBB症状缓解80 - 99%与100%的患者之间无显著差异。
