Young Andrew C, Deng Hao, Opalacz Arissa, Roth Sarah, Filatava Evgenia Jen, Fisher Corrie A, de Sousa Karina, Mogren Grace, Chen Lucy
Department of Neurology, Boston University School of Medicine, Boston, MA; Boston Medical Center, Boston, MA.
Department of Anesthesia, Massachusetts General Hospital, Boston, MA.
Pain Physician. 2022 Mar;25(2):E341-E347.
Sacroiliac joint (SIJ) pain is a common etiology of chronic lower back pain. Treatment of persistent sacroiliac joint pain may entail intraarticular steroid injections and lateral branch radiofrequency neurotomy.
This study evaluates the efficacy of SIJ intervention treatments by comparing intraarticular steroid injections with lateral branch radiofrequency neurotomy.
Retrospective cohort study.
We reviewed electronic medical records of patients with SIJ pain at Massachusetts General Hospital from 2006 through 2016 and identified 354 patients who received 930 SIJ intraarticular injections and 19 patients who received 41 SIJ lateral branch radiofrequency neurotomies.
The Numeric Rating Scale (NRS) score for pain and the Eastern Cooperative Oncology Group (ECOG) Performance Status were measured prior to intervention and on follow-up. A mixed effects model was used to evaluate the duration of treatment effect.
Patients who received an SIJ intraarticular steroid injection reported lower pain scores following treatment with a mean (standard deviation) NRS reduction from 6.77 (2.25) to 2.72 (2.81). SIJ lateral branch radiofrequency neurotomy resulted in NRS reduction from 5.96 (2.39) to 3.54 (3.14). A linear mixed model analysis suggests SIJ intraarticular steroid injections provided an estimated mean (CI 95%) of 38 (30-46.3) days of pain relief. Lateral branch radiofrequency neurotomy provided 82 (39.4-124.8) days of pain relief. The mean preprocedure ECOG score was 1.22 for both interventions and trended toward improvement with a post SIJ intraarticular injection score of 1.05 and SIJ lateral branch radiofrequency neurotomy score of 1.03.
There was variable follow-up reporting among patients. The small size of the lateral branch radiofrequency cohort limited intergroup comparisons.
Both SIJ intraarticular steroid injections and SIJ lateral branch radiofrequency neurotomy demonstrated significant pain relief for patients with SIJ pain. SIJ lateral branch radiofrequency neurotomy provided a longer duration of pain relief (82 days) versus SIJ intraarticular steroid injection (38 days).
骶髂关节（SIJ）疼痛是慢性下腰痛的常见病因。持续性骶髂关节疼痛的治疗可能需要关节内注射类固醇和外侧支射频神经切断术。
本研究通过比较关节内注射类固醇与外侧支射频神经切断术，评估骶髂关节干预治疗的疗效。
回顾性队列研究。
我们回顾了2006年至2016年在马萨诸塞州总医院患有骶髂关节疼痛患者的电子病历，确定了354例接受930次骶髂关节内注射的患者和19例接受41次骶髂关节外侧支射频神经切断术的患者。
在干预前和随访时测量疼痛的数字评定量表（NRS）评分和东部肿瘤协作组（ECOG）体能状态。使用混合效应模型评估治疗效果的持续时间。
接受骶髂关节内类固醇注射的患者在治疗后报告疼痛评分较低，平均（标准差）NRS评分从6.77（2.25）降至2.72（2.81）。骶髂关节外侧支射频神经切断术使NRS评分从5.96（2.39）降至3.54（3.14）。线性混合模型分析表明，骶髂关节内类固醇注射提供的估计平均（95%CI）疼痛缓解天数为38（30-46.3）天。外侧支射频神经切断术提供了82（39.4-124.8）天的疼痛缓解。两种干预措施术前的平均ECOG评分为1.22，骶髂关节内注射后评分为1.05，骶髂关节外侧支射频神经切断术后评分为1.03，均有改善趋势。
患者的随访报告存在差异。外侧支射频队列规模较小，限制了组间比较。
骶髂关节内类固醇注射和骶髂关节外侧支射频神经切断术均能显著缓解骶髂关节疼痛患者的疼痛。与骶髂关节内类固醇注射（38天）相比，骶髂关节外侧支射频神经切断术提供的疼痛缓解持续时间更长（82天）。
