Pain Management Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Pain Management Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands.
Pain Physician. 2023 Jul;26(4):E353-E361.
Chronic cervical facet joint pain is a leading cause of pain and disability. In patients nonresponsive to conservative treatment, cervical facet radiofrequency ablation (RFA) has shown to be efficacious. However, the conventional RFA technique can be cumbersome. A novel RFA technique with a multitined cannula allows for a lateral approach and represents an attractive alternative option for cervical facet RFA. It offers a potentially shorter, less cumbersome procedure, with consequently less x-ray exposure and patient discomfort than the conventional cervical RFA.
To describe the novel RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain.
This is a single-center observational study.
Interventional Pain Management Center, Switzerland.
The aim of this study is to describe the RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. Eligible adult patients with chronic (> 3 months) cervical facet joint pain refractory to conservative treatment and confirmed by dual positive medial branch blocks, received a fluoroscopic-guided cervical facet RFA treatment using the multitined cannula. The primary outcome was pain relief. Secondary outcome measures included the proportion of patients reporting a >= 30% reduction of pain intensity 2 months after RFA, patient global impression of change (PGIC), need for pain medication, sleep quality, and patient satisfaction.
We included 26 patients. The patients showed a clinically meaningful and significant pain relief at 2 months after cervical facet RFA (mean Numeric Rating Scale of 7.5 [1.9] at baseline to 4.2 [2.4]) and 58% of the patients reported >= 30% reduction of pain. An improvement on the PGIC was reported by 88.2% of the patients. No severe side effects or complications were observed.
Key limitations of our study were the relatively small sample size, the lack of a control group, and a relatively short-term follow-up duration.
Our results suggest that cervical facet joint RFA using the novel technique with the multitined cannula results in significant pain reduction and improvement on the PGIC. While the conventional technique requires multiple ablations at each target level, the RFA with the multitined needle requires only a singular ablation, likely sparing time, radiation dose, discomfort, and costs. Our results merit consideration of replacement of the conventional technique with the novel technique using the multitined cannula. However, larger-scale clinical trials with an adequate long-term follow-up period are needed to prove the efficacy of RFA using the multitined cannula in cervical facet joint pain.
慢性颈椎关节突关节痛是疼痛和残疾的主要原因。对于非保守治疗反应不佳的患者，颈椎关节突射频消融术 (RFA) 已被证明是有效的。然而，传统的 RFA 技术可能很繁琐。一种新的带有多齿套管的 RFA 技术可实现侧入路，是颈椎关节突 RFA 的一种有吸引力的替代选择。它提供了一种潜在的更短、更不繁琐的程序，与传统的颈椎 RFA 相比，放射暴露和患者不适更少。
描述使用多齿套管进行侧向入路的新型 RFA 技术，并评估其在慢性颈椎关节突关节痛中的疗效。
这是一项单中心观察性研究。
瑞士介入性疼痛管理中心。
本研究的目的是描述使用多齿套管进行侧向入路的 RFA 技术，并评估其在慢性颈椎关节突关节痛中的疗效。符合条件的慢性 (>3 个月) 颈椎关节突疼痛且对保守治疗无反应并经双重内侧支阻滞阳性证实的成年患者，接受了多齿套管引导的颈椎关节突射频消融术治疗。主要结果是疼痛缓解。次要结果包括 2 个月后 RFA 后疼痛强度降低>=30%的患者比例、患者总体印象变化 (PGIC)、对疼痛药物的需求、睡眠质量和患者满意度。
我们纳入了 26 名患者。患者在颈椎关节突 RFA 后 2 个月表现出有临床意义的显著疼痛缓解(基线时的平均数字评定量表为 7.5[1.9]，2 个月时为 4.2[2.4])，58%的患者报告疼痛减轻>=30%。88.2%的患者报告 PGIC 改善。未观察到严重的副作用或并发症。
本研究的主要局限性是样本量相对较小、缺乏对照组和随访时间相对较短。
我们的结果表明，使用新型多齿套管技术进行颈椎关节突关节 RFA 可显著减轻疼痛并改善 PGIC。虽然传统技术需要在每个目标水平进行多次消融，但多齿针的 RFA 仅需单次消融，可能节省时间、辐射剂量、不适和成本。我们的结果值得考虑用新型多齿套管技术替代传统技术。然而，需要更大规模的临床试验和足够长的随访期来证明多齿套管颈椎关节突关节 RFA 的疗效。
