Liu Michelle, Shaparin Naum, Nair Singh, Kim Ryung S, Hascalovici Jacob R
Saul R. Korey Department of Neurology, Montefiore Medical Center, Bronx, NY.
Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY; The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, NY; Department of Anesthesiology, Montefiore Medical Center, Bronx, NY.
Pain Physician. 2021 Jul;24(4):E521-E528.
Chronic low back pain (CLBP) is an extremely prevalent disease, whose etiology is often multifactorial. Facet joint arthropathy is one of the most common causes of CLBP. Facet joints are innervated by the medial branches of the primary and adjacent level dorsal rami and are, therefore, key potential targets for the symptomatic management of CLBP. A lumbar medial branch nerve block (MBB) procedure is often used to assist in the diagnosis of facet mediated CLBP. For unclear reasons, some patients experience protracted relief of CLBP after diagnostic MBBs alone.
To describe the phenomenon of protracted relief of CLBP after diagnostic MBBs and search for predictors of this response.
A retrospective chart review of patients who underwent MBB procedures by a single practitioner, over a 2 year period, was conducted.
All patients were seen at the Montefiore Multidisciplinary Pain Program, Bronx, NY.
Data from follow up visits was used to categorize patient's response to MBBs as having no relief (NR), transient relief (TR) or protracted relief (PR). Patient demographics and characteristics were collected, and a multivariate analysis investigating associations with PR was conducted.
146 patients met inclusion criteria. 41 patients (28%) had NR, 54 (37%) had TR, and 51 (35%) had PR. CLBP symptom duration of < 6 months (P = 0.013) and unilateral back pain symptoms (P = 0.0253) were significantly associated with PR after MBB.
This is a retrospective study with a relatively small sample size conducted on patients belonging to a single practitioner. Outcomes were based largely on subjective patient satisfaction scores.
In select patients, MBB may produce protracted relief of CLBP symptoms. The authors present distinct hypotheses which may help explain the therapeutic effects of diagnostic MBB procedures.
慢性下腰痛（CLBP）是一种极为常见的疾病，其病因通常是多因素的。小关节病是CLBP最常见的病因之一。小关节由初级和相邻节段背侧支的内侧支支配，因此是CLBP症状性治疗的关键潜在靶点。腰椎内侧支神经阻滞（MBB）手术常被用于辅助诊断小关节介导的CLBP。由于不明原因，一些患者仅在诊断性MBB后就经历了CLBP的长期缓解。
描述诊断性MBB后CLBP长期缓解的现象，并寻找这种反应的预测因素。
对一位医生在两年内进行MBB手术的患者进行回顾性病历审查。
所有患者均在纽约州布朗克斯区的蒙特菲奥里多学科疼痛项目就诊。
随访就诊数据用于将患者对MBB的反应分类为无缓解（NR）、短暂缓解（TR）或长期缓解（PR）。收集患者的人口统计学和特征数据，并进行多变量分析以研究与PR的相关性。
146例患者符合纳入标准。41例患者（28%）无缓解，54例（37%）短暂缓解，51例（35%）长期缓解。MBB后CLBP症状持续时间<6个月（P = 0.013）和单侧背痛症状（P = 0.0253）与PR显著相关。
这是一项对属于单一医生的患者进行的回顾性研究，样本量相对较小。结果很大程度上基于患者主观满意度评分。
在特定患者中，MBB可能会使CLBP症状长期缓解。作者提出了不同的假设，可能有助于解释诊断性MBB手术的治疗效果。
