Spine (Phila Pa 1976). 2022 Sep 1;47(17):1187-1193. doi: 10.1097/BRS.0000000000004392. Epub 2022 Jul 1.
This was a single-center prospective randomized controlled study.
The aim was to compare the efficacy of endoscopic facet joint denervation (FJD) with that of the percutaneous technique in terms of pain, functional disability, and quality of life in patients with low back pain (LBP).
Different controlled studies in patients with LBP have shown short-term benefits from percutaneous FJD. Observational studies have demonstrated that endoscopic FJD may be more effective. As the superiority of the endoscopic technique has not been clearly demonstrated in previous studies, a prospective randomized controlled study was conducted.
For this study, 40 patients with LBP lasting more than 6 months duration and at least 50% pain reduction on the visual analog scale after medial branch block under fluoroscopy, were assigned randomly to receive percutaneous or endoscopic FJD. The primary outcome was pain, as indicated by visual analog scale. Secondary outcomes were functional disability, as assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and quality of life, as assessed by the Short Form Health Survey (SF-36).
After the intervention, the pain level decreased significantly in both groups ( P <0.001); however, the effect was still significant in the endoscopic group (EG) and diminished to lower than the statistical significance in the percutaneous group (PG) after 12 months. The ODI and RDQ scores also improved significantly in both groups ( P <0.001). However, the ODI and RDQ were significantly better ( P <0.001) in the EG after 12 months. In the SF-36, we observed significant improvement in both groups three months after the intervention. The effect decreased after six months in the PG and was predominantly not demonstrable after 12 months, whereas in the EG there was still a strong significant improvement on all scales ( P <0.001) after 12 months.
Percutaneous and endoscopic FJD reduced pain and improved functionality and quality of life. However, the effects decreased or disappeared in the PG after 12 months, whereas there was still a strong significant improvement in the EG.
这是一项单中心前瞻性随机对照研究。
旨在比较内镜下关节突关节脊神经切断术（FJD）与经皮技术在治疗腰痛（LBP）患者疼痛、功能障碍和生活质量方面的疗效。
不同的对照研究表明，经皮 FJD 可在短期内带来益处。观察性研究表明，内镜下 FJD 可能更有效。由于之前的研究并未明确显示内镜技术的优越性，因此进行了一项前瞻性随机对照研究。
本研究纳入了 40 例腰痛持续时间超过 6 个月且在透视下内侧支阻滞后疼痛减轻至少 50%的患者，随机分为经皮或内镜 FJD 组。主要结局指标为视觉模拟评分（VAS）所示疼痛。次要结局指标为 Oswestry 功能障碍指数（ODI）、Roland-Morris 残疾问卷（RDQ）评估的功能障碍和健康调查简表 36 项（SF-36）评估的生活质量。
干预后，两组疼痛水平均显著下降（P<0.001）；然而，内镜组（EG）的效果仍显著，而经皮组（PG）在 12 个月后降至低于统计学意义的水平。两组 ODI 和 RDQ 评分均显著改善（P<0.001）。然而，12 个月后 EG 的 ODI 和 RDQ 明显更好（P<0.001）。SF-36 方面，我们观察到干预后 3 个月两组均有显著改善。PG 组在 6 个月后效果下降，12 个月后主要无法显示，而 EG 组在 12 个月后所有评分仍有强烈显著改善（P<0.001）。
经皮和内镜 FJD 均可减轻疼痛，改善功能和生活质量。然而，PG 组在 12 个月后效果下降或消失，而 EG 组仍有强烈显著改善。
