Terao Tohru, Kato Naoki, Sasaki Yuichi, Ohara Keiichirou, Michishita Shoutarou, Nakayama Yosuke, Hadano Keisuke, Karagiozov Kostadin, Tani Satoshi, Murayama Yuichi
Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, Japan.
Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Neurol Sci. 2022 Jan;43(1):593-601. doi: 10.1007/s10072-021-05298-9. Epub 2021 May 10.
Severe low back pain (LBP) is an occasional complaint in patients with neuromuscular disorders (NMDs). Accurate diagnosis and treatment are required to manage LBP; however, the precise pathophysiology differs for each patient. This study aimed to evaluate the efficacy of lumbar facet joint denervation (FJD) and adjunctive modalities in the treatment of LBP in patients with NMD-associated kyphoscoliosis.
A total of 16 patients (22 sites) with NMD (bilateral, n = 6; unilateral, n = 10) and LBP treated with lumbar FJD were evaluated. The patients were divided into two groups: those treated with FJD alone (group 1) and those treated with multimodal treatment, including FJD along with radiofrequency ablation for sacroiliac joint pain, piriform muscle block, botulinum toxin injection into the paraspinal muscles, spinal cord stimulation, or any of their combinations (group 2). All patients were followed up for 48 weeks postoperatively. The two groups were compared with respect to the duration required for improvements in LBP by more than 50% (numerical rating scale ≤ 5).
There was no significant difference between the groups regarding the age, duration since the onset of Parkinson's syndrome, and radiographic analysis. The effective period of improved pain was greater in group 2 than in group 1 (30.7 vs. 8.4 weeks, P < 0.01).
Multimodal treatment including FJD is safe and relatively effective in patients with NMD-associated kyphoscoliosis. Hence, it is a potential substitute for conventional spinal fixation surgery, which has a higher risk of complications.
严重的下腰痛（LBP）是神经肌肉疾病（NMD）患者偶尔出现的症状。LBP的管理需要准确的诊断和治疗；然而，每个患者的确切病理生理学有所不同。本研究旨在评估腰椎小关节去神经支配术（FJD）及辅助治疗方法对NMD相关脊柱侧凸患者LBP的治疗效果。
对16例（22个部位）接受腰椎FJD治疗的NMD（双侧，n = 6；单侧，n = 10）和LBP患者进行评估。患者分为两组：单纯接受FJD治疗的患者（第1组）和接受多模式治疗的患者，包括FJD联合针对骶髂关节疼痛的射频消融、梨状肌阻滞、椎旁肌注射肉毒杆菌毒素、脊髓刺激或它们的任何组合（第2组）。所有患者术后随访48周。比较两组LBP改善超过50%（数字评分量表≤5）所需的时间。
两组在年龄、帕金森综合征发病后的病程及影像学分析方面无显著差异。第2组疼痛改善的有效时间长于第1组（30.7周对8.4周，P < 0.01）。
包括FJD的多模式治疗对NMD相关脊柱侧凸患者是安全且相对有效的。因此，它是具有较高并发症风险的传统脊柱固定手术的潜在替代方法。
