Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
Pain Med. 2021 Feb 23;22(2):266-272. doi: 10.1093/pm/pnaa381.
Radiofrequency ablation (RFA) of the medial branch nerve is a commonly performed procedure for patients with facet syndrome. RFA has previously been demonstrated to provide long-term functional improvement in approximately 50% of patients, including those who had significant pain relief after diagnostic medial branch block. We sought to identify factors associated with success of RFA for facet pain.
Active-duty military patients who underwent lumbar RFA (L3, L4, and L5 levels) over a 3-year period were analyzed. Defense and Veterans Pain Rating Scale (DVPRS) and Oswestry Disability Index (ODI) scores were assessed the day of procedure and at the 2-month and 6-month follow-up. These data were analyzed to identify associations between patient demographics, pain, and functional status and patients' improvement after RFA, with a primary outcome of ODI improvement and a secondary outcome of pain reduction.
Higher levels of starting functional impairment (starting ODI scores of 42.9 vs. 37.5; P = 0.0304) were associated with a greater likelihood of improvement in functional status 6 months after RFA, and higher starting pain scores (DVPRS pain scores of 6.1 vs. 5.1; P < 0.0001) were associated with a higher likelihood that pain scores would improve 6 months after RFA. A multivariate logistic regression was then used to develop a scoring system to predict improvement after RFA. The scoring system generated a C-statistic of 0.764, with starting ODI, pain scores, and both gender and smoking history as independent variables.
This algorithm compares favorably to that of diagnostic medial branch block in terms of prediction accuracy (C-statistic of 0.764 vs. 0.57), suggesting that its use may improve patient selection in patients who undergo RFA for facet syndrome.
射频消融（RFA）治疗内侧支神经是治疗小关节综合征的常用方法。先前的研究表明，RFA 可使约 50%的患者长期功能改善，包括那些在接受内侧支阻滞诊断性治疗后疼痛明显缓解的患者。我们试图确定与 RFA 治疗小关节疼痛成功相关的因素。
对过去 3 年中接受腰椎 RFA（L3、L4 和 L5 水平）治疗的现役军人患者进行分析。在手术当天以及术后 2 个月和 6 个月，使用国防和退伍军人疼痛评分量表（DVPRS）和 Oswestry 残疾指数（ODI）评分进行评估。分析这些数据，以确定患者人口统计学、疼痛和功能状态与患者 RFA 后改善之间的关联，主要结果是 ODI 改善，次要结果是疼痛减轻。
更高的起始功能障碍水平（起始 ODI 评分分别为 42.9 分和 37.5 分；P=0.0304）与 RFA 后 6 个月功能状态改善的可能性更大相关，更高的起始疼痛评分（DVPRS 疼痛评分分别为 6.1 分和 5.1 分；P<0.0001）与 RFA 后 6 个月疼痛评分改善的可能性更大相关。然后使用多变量逻辑回归建立评分系统以预测 RFA 后的改善。评分系统生成的 C 统计量为 0.764，其中起始 ODI、疼痛评分以及性别和吸烟史为独立变量。
该算法在预测准确性方面与内侧支阻滞诊断性治疗相比具有优势（C 统计量分别为 0.764 和 0.57），这表明其在接受 RFA 治疗小关节综合征的患者中可能有助于改善患者选择。
