Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
Spine (Phila Pa 1976). 2023 Oct 15;48(20):1455-1463. doi: 10.1097/BRS.0000000000004776. Epub 2023 Jul 20.
A scoping review.
We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs).
FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections.
We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes.
Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes.
Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.
范围综述。
我们旨在确定并描述与腰椎关节突关节（FJ）内注射或内侧支阻滞（MBB）后患者报告的反应相关的因素。
FJ 骨关节炎是慢性下腰痛最常见的原因之一。治疗通常包括 FJ 关节内注射和 MBB（随后可能对支配这些关节的神经进行射频消融）。然而，这些方法的成功率各不相同，这促使人们关注与这些类型的 FJ 注射反应相关的患者特征（影像学特征、临床体征等）。
我们对 2000 年至 2023 年间以英文或西班牙文发表的与腰椎 FJ 关节内注射或 MBB 后患者报告的结局相关的因素进行了文献检索，这些因素与接受低背痛治疗的患者相关。我们排除了未描述与结局相关的因素或描述其他干预措施的重复论文。我们收集了这些因素与患者报告结局之间关联的数据。
有 37 项研究符合纳入标准并进行了分析。这些研究评估了年龄、抑郁和单光子发射计算机断层扫描（SPECT）等因素，以及变量。年龄和 FJ 关节炎的影像学表现是最常描述的因素。FJ 关节炎的影像学表现和 SPECT 阳性通常与关节内 FJ 注射或 MBB 后的阳性结果相关。相比之下，年龄较小和吸烟与不太理想的临床结局相关。
在本综述纳入的 37 项研究中考虑了许多因素。关节突关节炎的影像学表现、疼痛持续时间和 SPECT 阳性与关节突干预后的良好结果一致相关。
