Pinnacle Health Sciences Centre Scarborough, Toronto, ON, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Adv Ther. 2022 Aug;39(8):3539-3546. doi: 10.1007/s12325-022-02183-5. Epub 2022 Jun 9.
BACKGROUND: Chronic lower back pain (LBP) with or without leg pain (LP) is the most commonly reported anatomical site of pain among Canadian adults with chronic pain. A common cause for LBP and LP arises from dysfunction of the sacroiliac joint (SIJ) complex. When conventional medical management or rehabilitative efforts for SIJ-related LBP and LP fail to provide analgesia, pulsed radiofrequency (PRF) and/or radiofrequency ablation (RFA) of the dorsal entry root zone complex lesions (DREZC) and/or their more peripheral branches can also be a suitable means for treatment. Both PRF and RFA are interventional techniques that utilize heat to attenuate or ablate transmission of painful signals, respectively. The purpose of this chart review is to explore the clinical outcomes of patients experiencing SIJ-related pain who have undergone procedures with combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex. METHODS: Following institutional review board approval, a retrospective chart review was performed from June 2018 to February 2021 for patients with LBP and/or LP refractory to physical rehabilitative efforts and medical management that underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. RF and PRF procedures were anatomically guided with the addition of sensory stimulation to ensure appropriate needle placement. Charts were reviewed for percentage of analgesia at final follow-up, duration of effect, degree of analgesia, patients' functional improvements, and changes in medication use patterns. RESULTS: Data was reviewed from 180 patients with LBP or LP who underwent combined PRF and RF treatments for a diagnosis of SIJ complex pain. The group consisted of 69 men and 111 women with a mean age of 59 years. All patients had lesions to their dorsal roots and/or branches (lumbar medial and sacral lateral), as determined using their pain profile as well as sensory stimulation. In the sample of 180 patients a total of 276 SIJs were treated over the period of data collection. Overall, 85.0% (n = 234) of procedures were considered successful with more than 50% analgesic relief at final follow-up. Of 234 successful outcomes, 110 reported ongoing analgesia (mean = 80.3% pain relief, SD ± 18.0) on the last date of follow up (mean = 53.2 days, SD ± 41.8) prior to being lost to follow-up. For patients not lost to follow-up, the mean amount of analgesia was reported to be 83.9% with an average duration of 86.3 days. Among all treatments, 6.9% (n = 19) provided no analgesic effect. Among the successful procedure outcomes, 54.4% (n = 150) reported increased activity/mobility, 24.3% (n = 67) reported improved sleep, 49.3% (n = 136) reported improved mood, and 11.6% (n = 32) reported decreased medication usage. Nine patients reported complications following the procedure. Complications included transient soreness, bruising, tenderness, myofascial pain, and two mild vagal responses without lasting sequelae. CONCLUSION: This review suggests that combined sensory nerve branch RFA and DREZC PRF lesions targeting the SIJ complex is a suitable intervention to treat SIJ-related LBP and/or LP refractory to physical rehabilitative efforts and medical management. Approximately 85% of these cases were successfully treated with the majority of patients report lasting analgesic effects with minimal complications, supporting the use of sensory stimulation-guided combined RF and PRF lesions for treatment of refractory SIJ complex pain.
背景:慢性下腰痛(LBP)伴或不伴腿痛(LP)是加拿大慢性疼痛成年患者最常报告的疼痛解剖部位。LBP 和 LP 的一个常见原因是骶髂关节(SIJ)复合体功能障碍。当常规医学管理或康复治疗 SIJ 相关的 LBP 和 LP 未能提供镇痛时,脉冲射频(PRF)和/或射频消融(RFA)背根入口区复合体病变(DREZC)及其更外围分支也可以是一种合适的治疗方法。PRF 和 RFA 都是利用热来减轻或消除疼痛信号传输的介入技术。本图表回顾的目的是探讨接受针对 SIJ 复合体的联合感觉神经分支 RFA 和 DREZC PRF 病变治疗的 SIJ 相关疼痛患者的临床结果。
方法:在获得机构审查委员会批准后,从 2018 年 6 月至 2021 年 2 月,对接受物理康复治疗和药物治疗无效的 LBP 和/或 LP 患者进行了回顾性图表审查,这些患者接受了联合 PRF 和 RF 治疗,以诊断为 SIJ 复合性疼痛。RF 和 PRF 程序通过解剖学引导,并结合感觉刺激,以确保适当的针放置。对图表进行了分析,以了解最终随访时的镇痛百分比、效果持续时间、镇痛程度、患者的功能改善以及药物使用模式的变化。
结果:对 180 例接受 PRF 和 RF 联合治疗以诊断 SIJ 复合性疼痛的 LBP 或 LP 患者的数据进行了回顾。该组包括 69 名男性和 111 名女性,平均年龄为 59 岁。所有患者均有背根和/或分支病变(腰椎内侧和骶外侧),这是根据他们的疼痛特征和感觉刺激确定的。在 180 例患者的样本中,共有 276 个 SIJ 在数据收集期间接受了治疗。总的来说,85.0%(n=234)的手术被认为是成功的,最终随访时超过 50%的患者有镇痛缓解。在 234 例成功结果中,110 例报告在最后一次随访(平均 53.2 天,SD±41.8)前持续镇痛(平均 80.3%的疼痛缓解,SD±18.0)。对于未失访的患者,报告的平均镇痛程度为 83.9%,平均持续时间为 86.3 天。在所有治疗中,6.9%(n=19)没有镇痛效果。在成功的手术结果中,54.4%(n=150)报告活动/移动能力增加,24.3%(n=67)报告睡眠改善,49.3%(n=136)报告情绪改善,11.6%(n=32)报告药物使用减少。9 例患者在手术后出现并发症。并发症包括短暂疼痛、瘀伤、压痛、肌筋膜疼痛和两次轻度迷走神经反应,但无持久后遗症。
结论:本综述表明,针对 SIJ 复合体的联合感觉神经分支 RFA 和 DREZC PRF 病变是治疗对物理康复治疗和药物管理无效的 SIJ 相关 LBP 和/或 LP 的合适干预措施。这些病例中约有 85%成功治疗,大多数患者报告持续的镇痛效果,并发症最小,支持使用感觉刺激引导的联合 RF 和 PRF 病变治疗难治性 SIJ 复合性疼痛。
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