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慢性下腰痛患者射频去神经术的前瞻性分析

Prospective analysis of radiofrequency denervation in patients with chronic low back pain.

作者信息

Aransay Álvaro Los Santos, Valladares Álvaro Camblor, Muñoz Roi Castro, Parrilla Ángel Ramón Piñera, Muñiz Iván Pipa, Cuello Lorien García, Negreira Javier Mateo

机构信息

Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain.

Department of Orthopaedics, Da Costa Hospital, Burela (Galicia, Spain), Rafael Vior, Lugo, Spain.

出版信息

J Spine Surg. 2020 Dec;6(4):703-712. doi: 10.21037/jss-20-599.

Abstract

BACKGROUND

To analyse the effectiveness of lumbar rhizolysis in patients with facet joint-related chronic low back pain and to study the influence of various variables on the results. Facet joints are thought to be responsible for up to 15% of all cases of chronic low back pain. Although radiofrequency denervation of these joints is a common procedure, there is currently no solid evidence to allow the selection of patients who may be candidates for this technique to be selected or the effectiveness and safety thereof to be demonstrated.

METHODS

A prospective analytical study of 100 patients treated with lumbar rhizolysis at the Hospital Universitario de Cabueñes (Gijón, Spain) between 2016 and 2019. Various demographic variables, the evolution of the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and consumption of analgesics pre- and postoperatively was analysed at 2, 6, 12 and 24 months.

RESULTS

The mean age of our sample was 57.8 years (27.0-85.5), with a BMI of 27.09 (16.14-46.22), and 63.8% of subjects were female. The mean duration of the symptoms prior to the intervention was 8.7 years, with 28.7% of subjects having a history of spinal surgery. The intervention resulted in a significant reduction in analgesics consumption. Moreover, a statistically significant reduction in pure low back pain, radiating pain and in the ODI in the short to medium term was observed with respect to baseline. We found that being female, having a history of prior low back surgery, the time to progression and the analgesic level consumed by the patient were related to a greater disability.

CONCLUSIONS

Lumbar rhizolysis results in a significant reduction in pain and functional disability in patients with chronic low back pain in both the short- and medium-term, and reduces the need for analgesics consumption.

摘要

背景

分析腰椎神经根松解术对小关节相关慢性下腰痛患者的有效性,并研究各种变量对结果的影响。小关节被认为是所有慢性下腰痛病例中高达15%的病因。尽管对这些关节进行射频去神经支配是一种常见的手术,但目前尚无确凿证据来选择可能适合该技术的患者,也无法证明其有效性和安全性。

方法

对2016年至2019年在西班牙希洪卡韦涅斯大学医院接受腰椎神经根松解术治疗的100例患者进行前瞻性分析研究。分析了各种人口统计学变量、视觉模拟量表(VAS)、Oswestry功能障碍指数(ODI)的变化以及术前和术后2、6、12和24个月的镇痛药使用情况。

结果

我们样本的平均年龄为57.8岁(27.0 - 85.5岁),体重指数为27.09(16.14 - 46.22),63.8%的受试者为女性。干预前症状的平均持续时间为8.7年,28.7%的受试者有脊柱手术史。干预导致镇痛药使用量显著减少。此外,与基线相比,在短期至中期观察到单纯下腰痛、放射痛和ODI有统计学显著降低。我们发现女性、既往有下腰痛手术史、病情进展时间以及患者使用的镇痛药水平与更大的功能障碍有关。

结论

腰椎神经根松解术在短期和中期均能显著减轻慢性下腰痛患者的疼痛和功能障碍,并减少镇痛药的使用需求。

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