射频消融治疗颈椎小关节源性疼痛和颈源性头痛的系统评价。

Cervical Facet Joint Pain and Cervicogenic Headache Treated With Radiofrequency Ablation: A Systematic Review.

机构信息

Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI.

Department of Rehabilitation Medicine, Montefiore Medical Center, SUNY-Buffalo, Buffalo, NY.

出版信息

Pain Physician. 2022 May;25(3):251-263.

PMID:35652765

Abstract

BACKGROUND

Chronic neck pain is often multifactorial and is a leading cause of pain and disability. Cervical facet joint pain is a common cause of neck pain and, in addition to more conservative modalities, can be treated with radiofrequency ablation (RFA) of the respective medial branch nerves. Cervicogenic headaches are a frequent complaint in pain clinics in the United States and can be targeted via a similar procedural approach.

OBJECTIVES

We evaluated randomized controlled trials of cervical facet joint pain and cervicogenic headaches with the goal of establishing a current level of evidence for treating these etiologies of pain with RFA.

STUDY DESIGN

Systematic review.

METHODS

Database search, from inception through July 2021, was performed identifying randomized controlled trials for cervical medial branch RFA. Two reviewers independently evaluated the studies to identify those meeting criteria. Primary outcome measures included pain relief and duration of pain relief. Secondary outcome measures included function, sleep, mood, return to work, additional treatments, and complications.

RESULTS

Four randomized controlled studies met inclusion criteria and were selected for this review, each demonstrated low risk of bias. Of these studies, 3 were unique with the fourth being a subgroup analysis. Primary outcome measures of pain relief and duration of relief were variable with successful relief ranging from 30% to 50% and median duration of pain relief also demonstrating a wide variety. Function and psychological distress were also variably reported and found variable relief to treatment with no difference between groups in 2 of the studies.

LIMITATIONS

Primary limitations of the review are the paucity of randomized controlled trials and the variability in measured outcome measures.

CONCLUSIONS

Based on this systematic review, efficacy of cervical facet RFA in treatment of chronic neck pain has Level II evidence.

摘要

背景

慢性颈痛通常是多因素的，是疼痛和残疾的主要原因。颈椎小关节疼痛是颈痛的常见原因，除了更保守的治疗方法外，还可以通过射频消融（RFA）治疗相应的内侧支神经。颈源性头痛在美国疼痛诊所中是一种常见的主诉，可以通过类似的治疗方法进行针对性治疗。

目的

我们评估了颈椎小关节疼痛和颈源性头痛的随机对照试验，目的是为这些病因的疼痛用 RFA 治疗建立当前的证据水平。

研究设计

系统评价。

方法

通过数据库搜索，从开始到 2021 年 7 月，确定了颈椎内侧支 RFA 的随机对照试验。两名审查员独立评估研究，以确定符合标准的研究。主要结局指标包括疼痛缓解和疼痛缓解持续时间。次要结局指标包括功能、睡眠、情绪、恢复工作、额外治疗和并发症。

结果

四项随机对照研究符合纳入标准，并被选入本综述，每项研究的偏倚风险均较低。其中 3 项研究是独特的，第 4 项是亚组分析。疼痛缓解和缓解持续时间的主要结局指标各不相同，成功率从 30%到 50%不等，缓解持续时间中位数也显示出很大的差异。功能和心理困扰也有不同程度的报告，治疗后也有不同程度的缓解，但在两项研究中，组间无差异。