Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA.
Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA.
Pain Med. 2021 May 21;22(5):1039-1054. doi: 10.1093/pm/pnab040.
Determine the effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain with type 1 or 2 Modic changes.
Systematic review.
Persons aged ≥18 years with chronic low back pain with type 1 or 2 Modic changes.
Intraosseous basivertebral nerve radiofrequency neurotomy.
Sham, placebo procedure, active standard care treatment, or none.
The primary outcome of interest was the proportion of individuals with ≥50% pain reduction. Secondary outcomes included ≥10-point improvement in function as measured by Oswestry Disability Index as well as ≥2-point reduction in pain score on the Visual Analog Scale or Numeric Rating Scale, and decreased use of pain medication.
Three reviewers independently assessed publications before May 15, 2020, in MEDLINE and Embase and the quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation framework.
Of the 725 publications screened, seven publications with 321 participants were ultimately included. The reported 3-month success rate for ≥50% pain reduction ranged from 45% to 63%. Rates of functional improvement (≥10-point Oswestry Disability Index improvement threshold) ranged from 75% to 93%. For comparison to sham treatment, the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 1.25 (95% confidence interval [CI]: .88-1.77) and 1.38 (95% CI: 1.10-1.73), respectively. For comparison to continued standard care treatment the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 4.16 (95% CI: 2.12-8.14) and 2.32 (95% CI: 1.52-3.55), respectively.
There is moderate-quality evidence that suggests this procedure is effective in reducing pain and disability in patients with chronic low back pain who are selected based on type 1 or 2 Modic changes, among other inclusion and exclusion criteria used in the published literature to date. Success of the procedure appears to be dependent on effective targeting of the BVN. Non-industry funded high-quality, large prospective studies are needed to confirm these findings.
确定骨内下脊椎神经射频神经切断术治疗 1 型或 2 型 Modic 改变的慢性下腰痛的疗效。
系统评价。
年龄≥18 岁、慢性下腰痛伴有 1 型或 2 型 Modic 改变的患者。
骨内下脊椎神经射频神经切断术。
假手术、安慰剂程序、主动标准护理治疗或无治疗。
主要结局为疼痛缓解≥50%的个体比例。次要结局包括功能改善≥10 分（Oswestry 残疾指数），疼痛评分降低≥2 分（视觉模拟量表或数字评分量表），以及疼痛药物使用减少。
三位审查员于 2020 年 5 月 15 日前分别独立评估了 MEDLINE 和 Embase 中的出版物，并使用推荐、评估、发展和评估分级框架评估证据质量。
在 725 篇筛选的出版物中，最终有 7 篇出版物的 321 名参与者被纳入。报告的 3 个月时疼痛缓解≥50%的成功率为 45%至 63%。功能改善（Oswestry 残疾指数改善≥10 分的阈值）的比例为 75%至 93%。与假手术相比，疼痛缓解≥50%和 Oswestry 残疾指数改善≥10 分的治疗成功率的相对风险分别为 1.25（95%置信区间：0.88-1.77）和 1.38（95%置信区间：1.10-1.73）。与继续标准护理治疗相比，疼痛缓解≥50%和 Oswestry 残疾指数改善≥10 分的治疗成功率的相对风险分别为 4.16（95%置信区间：2.12-8.14）和 2.32（95%置信区间：1.52-3.55）。
目前有中等质量的证据表明，对于根据 1 型或 2 型 Modic 改变等纳入和排除标准选择的慢性下腰痛患者，该手术可有效减轻疼痛和残疾。该手术的成功似乎取决于 BVN 的有效靶向。需要非工业资助的高质量、大型前瞻性研究来证实这些发现。
