Nwosu Marcellina, Agyeman Walter Y, Bisht Aakash, Gopinath Ankit, Cheema Ameer Haider, Chaludiya Keyur, Khalid Maham, Yu Ann Kashmer
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Interventional Pain Management and Primary Care, El Paso Pain Center, EL Paso, USA.
Cureus. 2023 Apr 4;15(4):e37114. doi: 10.7759/cureus.37114. eCollection 2023 Apr.
Intraosseous basivertebral nerve ablation has shown sustained efficacy in treating chronic axial low back pain (LBP) in patients with type 1 or 2 Modic changes. This systematic review aims to determine the efficacy of intraosseous basivertebral nerve radiofrequency ablation in treating nonradiating axial chronic LBP compared to standard therapy, sham, or without contrast. The population of interest is individuals greater than or equal to 18 years old with chronic nonradiating vertebrogenic pain. The key outcome was the percentage of patients with greater than or equal to 50% pain reduction, greater than or equal to 10-point improvement in function and disability measured by the Oswestry Disability Index (ODI), greater than or equal to two-point pain reduction in the visual analog scale (VAS) or numerical pain rating scale, and a decrease in opioid utilization by 10 morphine milligram equivalents. Three databases, PubMed, MEDLINE, and Google Scholar, were used to retrieve the studies for the review. Two independent reviewers assessed the studies for inclusion using the validated tools for quality appraisal. There were 286 articles in total; however, only 11 publications with extensive data on 413 participants matched the inclusion criteria and were used for this review. At three months, a majority of the participants reported greater than or equal to 10-point improvement in the ODI, a measure of functional and disability improvement on a 10-point scale, and greater than or equal to two-point improvement in the VAS. A good number of patients in the basivertebral nerve ablation (BVNA) arm reported complete pain resolution demonstrating therapy success and the superiority of BVNA over sham and standard treatment. Basivertebral nerve radiofrequency ablation, among other criteria, is a safe and minimally invasive therapy that significantly lowers pain and impairment in individuals with vertebrogenic pain with distinct Modic type 1 and 2 changes at lumbar vertebra three-sacral vertebra one (L3-S1) vertebral levels. Proper patient selection and exact procedural methods are essential to the success of basivertebral nerve neurotomy. The findings of the existing investigations require confirmation by nonindustry-funded, large-scale, high-quality trials using generalizable study participants.
骨内椎基神经消融术已显示出对患有1型或2型Modic改变的慢性轴性下腰痛(LBP)患者具有持续疗效。本系统评价旨在确定与标准治疗、假手术或无对照相比,骨内椎基神经射频消融术治疗非放射性轴性慢性LBP的疗效。感兴趣的人群为18岁及以上患有慢性非放射性脊椎源性疼痛的个体。关键结局指标包括疼痛减轻≥50%的患者百分比、采用Oswestry功能障碍指数(ODI)测量的功能和残疾改善≥10分、视觉模拟量表(VAS)或数字疼痛评分量表中疼痛减轻≥2分,以及阿片类药物使用量减少10毫克吗啡当量。使用三个数据库,即PubMed、MEDLINE和谷歌学术搜索来检索纳入本评价的研究。两名独立评审员使用经过验证的质量评估工具评估纳入研究。总共检索到286篇文章;然而,只有11篇包含413名参与者详细数据的出版物符合纳入标准并用于本评价。在三个月时,大多数参与者报告ODI改善≥10分(这是一种以10分为量表衡量功能和残疾改善情况的指标),VAS改善≥2分。椎基神经消融术(BVNA)组中有相当数量的患者报告疼痛完全缓解,表明治疗成功,且BVNA优于假手术和标准治疗。除其他标准外,椎基神经射频消融术是一种安全且微创的治疗方法,可显著降低腰椎3至骶椎1(L3 - S1)椎体水平具有明显1型和2型Modic改变的脊椎源性疼痛患者的疼痛和功能障碍。正确的患者选择和精确的手术方法对于椎基神经切断术的成功至关重要。现有研究结果需要通过非行业资助的、大规模、高质量的试验,使用具有广泛代表性的研究参与者来进行验证。