Manchikanti Laxmaiah, Kosanovic Radomir, Pampati Vidyasagar, Sanapati Mahendra R, Hirsch Joshua A
Pain Management Centers of America, Paducah, KY and Evansville, IN
Pain Management Centers of America, Paducah, KY.
Pain Physician. 2022 Jan;25(1):35-47.
Cervical facet joint pain is often managed with either cervical radiofrequency neurotomy, cervical medial branch blocks, or cervical intraarticular injections. However, the effectiveness of each modality continues to be debated. Further, there is no agreement in reference to superiority or inferiority of facet joint nerve blocks compared to radiofrequency neurotomy, even though cervical facet joint radiofrequency neurotomy has been preferred by many and in fact, has been mandated by the Centers for Medicare and Medicaid Services (CMS), except when radiofrequency cannot be confirmed. Each procedure has advantages and disadvantages in reference to clinical utility, outcomes, cost utility, and side effect profile. However, comparative analysis has not been performed thus far in the literature in a clinical setting.
A retrospective, case-control, comparative evaluation of outcomes and cost utility.
The study was conducted in an interventional pain management practice, a specialty referral center, a private practice setting in the United States.
To evaluate the clinical outcomes and cost utility of therapeutic medial branch blocks with radiofrequency neurotomy in managing chronic neck pain of facet joint origin.
The study was performed utilizing Strengthening the Reporting of Observational Studies in Epidemiology Analysis (STROBE) criteria. Only the patients meeting the diagnostic criteria of facet joint pain by means of comparative, controlled diagnostic local anesthetic blocks were included.The main outcome measure was pain relief measured by Numeric Rating Scale (NRS) evaluated at 3, 6, and 12 months. Significant improvement was defined as at least 50% improvement in pain relief. Cost utility was calculated with direct payment data for the procedures with addition of estimated indirect costs over a period of one year based on highly regarded surgical literature and previously published interventional pain management literature.
Overall, 295 patients met inclusion criteria with 132 patients receiving cervical medial branch blocks and 163 patients with cervical radiofrequency neurotomy. One hundred and seven patients in the cervical medial branch group and 105 patients in the radiofrequency group completed one year follow-up. There was significant improvement in both groups from baseline to 12 months with pain relief and proportion of patients with >= 50% pain relief. Average relief of each procedure for cervical medial branch blocks was 13 to 14 weeks, whereas for radiofrequency neurotomy, it was 20 to 25 weeks. Significant pain relief was recorded in 100%, 94%, and 81% of the patients in the medial branch blocks group, whereas it was 100%, 69%, and 64% in the radiofrequency neurotomy group at 3, 6, and 12 month follow-up, with significant difference at 6 and 12 months.Cost utility analysis showed average cost for quality-adjusted life year (QALY) of $4,994 for cervical medial branch blocks compared to $5,364 for cervical radiofrequency neurotomy. Six of 132 patients (5%) in the cervical medial branch group and 53 of 163 (33%) patients in the cervical radiofrequency neurotomy group were converted to other treatments, either due to side effects (6 patients or 4%) or inadequate relief (47 patients or 29%).
In this study, outcomes of cervical therapeutic medial branch blocks compared to radiofrequency neurotomy demonstrated significantly better outcomes with significant pain relief with similar costs for both treatments over a period of one year.
颈椎小关节疼痛的治疗通常采用颈椎射频神经切断术、颈椎内侧支阻滞或颈椎关节内注射。然而，每种治疗方式的有效性仍存在争议。此外，尽管许多人更倾向于颈椎小关节射频神经切断术，实际上医疗保险和医疗补助服务中心（CMS）也规定了该手术（除无法确认射频情况外），但对于小关节神经阻滞与射频神经切断术的优劣尚无定论。每种手术在临床应用、疗效、成本效益和副作用方面都有优缺点。然而，目前尚未有文献在临床环境中进行比较分析。
一项关于疗效和成本效益的回顾性、病例对照比较评估。
该研究在美国的一家介入性疼痛管理诊所、一个专科转诊中心和一家私人诊所进行。
评估治疗性内侧支阻滞联合射频神经切断术治疗颈椎小关节源性慢性颈部疼痛的临床疗效和成本效益。
本研究采用加强流行病学观察性研究报告分析（STROBE）标准进行。仅纳入通过对比、对照诊断性局部麻醉阻滞符合小关节疼痛诊断标准的患者。主要观察指标为通过数字评分量表（NRS）在3个月、6个月和12个月时评估的疼痛缓解情况。显著改善定义为疼痛缓解至少50%。成本效益根据手术的直接支付数据计算，并根据备受推崇的外科文献和先前发表的介入性疼痛管理文献，加上一年内估计的间接成本。
总体而言，295例患者符合纳入标准，其中132例接受颈椎内侧支阻滞，163例接受颈椎射频神经切断术。颈椎内侧支阻滞组107例患者和射频组105例患者完成了一年的随访。两组从基线到12个月时疼痛缓解情况及疼痛缓解≥50%的患者比例均有显著改善。颈椎内侧支阻滞每次手术的平均缓解期为13至14周，而射频神经切断术为20至25周。内侧支阻滞组患者在3个月、6个月和12个月随访时疼痛显著缓解的比例分别为100%、94%和81%，而射频神经切断术组分别为100%、69%和64%，在6个月和12个月时有显著差异。成本效益分析显示，颈椎内侧支阻滞每质量调整生命年（QALY）的平均成本为4994美元，而颈椎射频神经切断术为5364美元。颈椎内侧支阻滞组132例患者中有6例（5%），颈椎射频神经切断术组163例患者中有53例（33%）因副作用（6例或4%）或缓解不足（47例或29%）转而接受其他治疗。
在本研究中，与射频神经切断术相比，颈椎治疗性内侧支阻滞的疗效显著更好，在一年期间两种治疗的成本相似的情况下，疼痛得到显著缓解。
