Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea.
Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Pain Pract. 2024 Jun;24(5):772-785. doi: 10.1111/papr.13351. Epub 2024 Jan 31.
Pulsed radiofrequency (PRF) of the lumbar dorsal root ganglion (DRG) has been widely used as a method to relieve lumbar radicular pain (LRP). However, the value of PRF application in LRP patients remains uncertain. This systematic review aimed to compare the effects of PRF of lumbar DRG and LEI in patients with LRP.
A literature search was performed using well-known databases for articles published up to May 2023. We included randomized controlled trials (RCTs) that evaluated the effects of PRF compared to LEI with or without steroids. We screened articles, extracted data, and assessed risk of bias in duplicate. The pain scores and Oswestry Disability Index (ODI) scores at 1, 3, and 6 months after procedures were obtained. A random-effects meta-analysis model was applied for outcomes. We evaluated evidence certainty for each outcome using the GRADE scoring system. This review was registered in the PROSPERO (ID: CRD42021253628).
A total of 10 RCTs were included and data of 613 patients were retrieved. We assessed the overall quality of the evidence as very low to moderate. PRF showed no difference in pain scores at 1 (mean difference [MD] -0.80, 95% confidence interval [CI] -1.59 to 0.00, low certainty) and 6 months (MD -2.37, 95% CI -4.79 to 0.05, very low certainty), and significantly improved pain scores at 3 months (MD -1.31, 95% CI -2.29 to -0.33, low certainty). There was no significant difference in ODI score at any interval (very low to low certainty). In the subgroup who underwent a diagnostic block, did not use steroids, and PRF duration greater than 360 s, PRF significantly reduced pain scores at 3 months after procedures.
We found low quality of the evidence supporting adjuvant PRF to the lumbar DRG has a greater analgesic effect at 3 months after procedures in patients with LRP than LEI. We identified no convincing evidence to show that this treatment improves function. High-quality evidence is lacking, and data were largely derived from short-term effects. Given these limitations, high-quality trials with data on long-term effects are needed.
脉冲射频（PRF）治疗腰椎背根神经节（DRG）已广泛应用于缓解腰椎神经根痛（LRP）。然而，PRF 应用于 LRP 患者的价值仍不确定。本系统评价旨在比较 PRF 与 LEI 治疗 LRP 患者的效果。
我们对截至 2023 年 5 月发表的文献进行了全面的数据库检索，纳入了比较 PRF 与 LEI 联合或不联合类固醇治疗的随机对照试验（RCT）。我们对文章进行了筛选、数据提取，并进行了重复性偏倚风险评估。获得了术后 1、3 和 6 个月的疼痛评分和 Oswestry 功能障碍指数（ODI）评分。采用随机效应荟萃分析模型进行结局分析。我们使用 GRADE 评分系统对每个结局的证据确定性进行评估。本研究在 PROSPERO（ID：CRD42021253628）注册。
共纳入 10 项 RCT，共纳入 613 例患者。我们评估了整体证据质量为低至中。PRF 在术后 1 个月（平均差值 [MD] -0.80，95%置信区间 [CI] -1.59 至 0.00，低确定性）和 6 个月（MD -2.37，95% CI -4.79 至 0.05，非常低确定性）时的疼痛评分没有差异，而在术后 3 个月时疼痛评分显著改善（MD -1.31，95% CI -2.29 至 -0.33，低确定性）。在任何时间点，ODI 评分均无差异（非常低至低确定性）。在接受诊断性阻滞、未使用类固醇和 PRF 持续时间大于 360 秒的亚组中，PRF 术后 3 个月时疼痛评分显著降低。
我们发现，质量较低的证据支持辅助 PRF 治疗腰椎 DRG 对 LRP 患者在术后 3 个月时的镇痛效果优于 LEI。我们没有发现令人信服的证据表明这种治疗可以改善功能。缺乏高质量证据，数据主要来源于短期效果。鉴于这些局限性，需要开展高质量的、具有长期效果数据的试验。
