University of Montreal, Montreal, Quebec, Canada.
National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China.
Pain Physician. 2022 Nov;25(8):569-576.
Lumbar facet joint (LFJ) pain is the most common cause of low back pain in the elderly. Denervation of the medial branch of the spinal dorsal ramus can theoretically achieve long-term pain relief. Yet there is little evidence of high-level prospective randomized controlled research.
To observe the effect of radiofrequency (RF) denervation of the medial branch of the spinal dorsal ramus on LFJ pain in the elderly.
A prospective randomized controlled study.
The study was performed in the National Pain Management and Research Center of China-Japan Friendship Hospital.
A total of 270 patients over 60 years old with LFJ pain were randomly divided into an RF group (n = 135) and a control group (n = 135). They received radiofrequency denervation intervention and a conventional conservative approach, respectively. The follow-up was 6 months. The main outcome was the NRS pain score (0-10 points) and the proportion of patients with a pain reduction of more than 2 points (minimum difference of clinically significant difference). The secondary outcome was the Oswestry Disability Index (ODI), the proportion of patients whose ODI decreased by more than 15 points, and the Macnab standard efficacy evaluation. The factors that influenced the excellent and good Macnab rates were analyzed by univariate and multivariable regression analysis.
There were more women than men who suffered from LFJ (171/99) pain based in these 270 patients. The numeric rating scale (NRS) pain score changes in the RF group were significantly different from those in the control group at the 1st, 3rd, and 6th months (-2.3 vs -1.2, -2.0 vs -1.2, -2.0 vs -1.1, P < 0.001), and the proportion of patients whose NRS decreased by ? 2 was higher than that in the control group at the 3rd and 6th months (61.1% vs 26.0%, 52.9% vs 22.5%, P < 0.001). The ODI score changes in the RF group were significantly different from that in the control group at the 1st, 3rd, and 6th months (-15.2 vs -10.1, -14.6 vs -8.6, -13.6 vs -7.7, P < 0.001), and the proportion of ODI reduction ? 15 was also higher than that in the control group at the 3rd and 6th months (45.8% vs 34.1%, 36.4% vs 27.0%, P < 0.05). The excellent rate and efficiency of the Macnab evaluation in the RF group at the 6th month was significantly higher compared to the control group (60.3% vs 36.0%, 81.0% vs 54.1%, P < 0.001). The independent factor affecting the excellent and good rate is failed back surgery syndrome.
The limitation of this study is that it was only performed in one unit of the National Pain Management and Research Center. It needs to be further carried on in multiple centers in the future.
Radiofrequency denervation can effectively reduce LFJ pain and improve movement disorder. The effect is good until 6 months later.
腰椎小关节（LFJ）疼痛是老年人腰痛最常见的原因。脊神经后支内侧支的去神经支配在理论上可以实现长期的疼痛缓解。然而，几乎没有高水平前瞻性随机对照研究的证据。
观察射频（RF）脊神经后支内侧支去神经支配治疗老年腰椎小关节疼痛的效果。
前瞻性随机对照研究。
研究在中国-日本友好医院国家疼痛管理与研究中心进行。
将 270 名年龄在 60 岁以上的 LFJ 疼痛患者随机分为 RF 组（n=135）和对照组（n=135）。他们分别接受射频神经阻断干预和常规保守治疗。随访时间为 6 个月。主要结果是 NRS 疼痛评分（0-10 分）和疼痛减轻超过 2 分的患者比例（最小临床显著差异的差异）。次要结果是 Oswestry 残疾指数（ODI）、ODI 降低超过 15 分的患者比例和 Macnab 标准疗效评估。通过单变量和多变量回归分析，分析影响 Macnab 优良率的因素。
在这 270 名患者中，有 171 名女性（99 名男性）患有 LFJ 疼痛。RF 组的 NRS 疼痛评分变化在第 1、3 和 6 个月时与对照组有显著差异（-2.3 与-1.2、-2.0 与-1.2、-2.0 与-1.1，P<0.001），且第 3 和 6 个月时 NRS 降低超过 2 分的患者比例高于对照组（61.1%与 26.0%、52.9%与 22.5%，P<0.001）。RF 组的 ODI 评分变化在第 1、3 和 6 个月时与对照组有显著差异（-15.2 与-10.1、-14.6 与-8.6、-13.6 与-7.7，P<0.001），且第 3 和 6 个月时 ODI 降低超过 15 分的患者比例高于对照组（45.8%与 34.1%、36.4%与 27.0%，P<0.05）。在第 6 个月时，RF 组的 Macnab 评估的优良率和有效率明显高于对照组（60.3%与 36.0%、81.0%与 54.1%，P<0.001）。影响优良率的独立因素是失败的腰椎后路手术综合征。
本研究的局限性在于仅在中国-日本友好医院国家疼痛管理与研究中心的一个单位进行。未来需要在多个中心进一步开展。
射频去神经支配可以有效减轻腰椎小关节疼痛，改善运动障碍。效果持续至 6 个月后。
