与自然病程相比，腰椎内侧支射频神经切断术对成人脊柱侧凸患者Cobb角进展的影响：一项横断面研究。
The effect of lumbar medial branch radiofrequency neurotomy on cobb angle progression in individuals with adult scoliosis compared to natural history: A cross-sectional study.
作者信息
Caragea Marc, Le Austin, Curtis Tim, Ni Amelia, Clark Tyler, Joyce Andrew, Hickman Colton, Lawrence Brandon, Randell Zane, Goodman Perry, Poduska Addisyn, Rasmussen Michella, Cooper Amanda, Teramoto Masaru, Glinka Przybysz Allison, Burnham Taylor, Conger Aaron, McCormick Zachary L
机构信息
Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA.
Department of Orthopedics, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis, St. Louis, MO, USA.
出版信息
Interv Pain Med. 2024 Apr 17;3(2):100411. doi: 10.1016/j.inpm.2024.100411. eCollection 2024 Jun.
BACKGROUND
Lumbar radiofrequency neurotomy (LRFN) effectively alleviates zygapophyseal joint-mediated pain by coagulating medial branch nerves to disrupt nociceptive signaling pathways. The concomitant denervation of multifidus fibers has led to concern that LRFN may increase segmental instability and accelerate degenerative changes in patients with certain pre-existing spinal pathologies. There is a paucity of literature evaluating whether LRFN increases the progression of spinal curvature in patients with adult scoliosis.
OBJECTIVE
Compare the lumbosacral Cobb angle progression rate in patients with adult scoliosis who underwent LRFN to the annual progression rate of 0.83 ± 1.1° expected by natural history.
DESIGN
Cross-sectional study.
METHODS
Consecutive patients diagnosed with adult scoliosis who underwent LRFN to treat zygapophyseal joint-related low back pain were identified. Patient demographics, LRFN procedure details, and radiographs confirming scoliosis were collected from electronic medical records. Pre- and post-LRFN radiographs were used to calculate the average annual rate of Cobb angle progression. Data were analyzed using a Wilcoxon signed-rank test and a linear regression model.
RESULTS
Sixty patients (mean age 69.2 ± 11.6 years; 70.0 % female) met the criteria and were included in the analyses. The mean time to radiographic follow-up was 35.0 ± 22.7 months post-LRFN. The average Cobb angle progression was 0.54 ± 3.03° per year and did not differ significantly from the known natural progression rate of 0.83 ± 1.1° per year. None of the included covariates (body mass index, LRFN laterality, and number of levels denervated) were significantly associated with the average annual Cobb angle progression rate.
CONCLUSIONS
Our results suggest that LRFN has no appreciable effect on the rate of Cobb angle progression in patients with adult scoliosis.
背景
腰椎射频神经切断术（LRFN）通过凝固内侧支神经以破坏伤害性信号传导通路，有效减轻关节突关节介导的疼痛。多裂肌纤维的伴随去神经支配引发了人们对LRFN可能会增加节段性不稳定并加速某些已有脊柱病变患者退变改变的担忧。目前缺乏评估LRFN是否会增加成人脊柱侧凸患者脊柱侧弯进展的文献。
目的
比较接受LRFN的成人脊柱侧凸患者腰骶部Cobb角进展率与自然病程预期的每年0.83±1.1°的进展率。
设计
横断面研究。
方法
纳入连续诊断为成人脊柱侧凸并接受LRFN治疗关节突关节相关下腰痛的患者。从电子病历中收集患者人口统计学资料、LRFN手术细节以及确认脊柱侧凸的X线片。使用LRFN术前和术后的X线片计算Cobb角进展的平均年率。采用Wilcoxon符号秩检验和线性回归模型进行数据分析。
结果
60例患者（平均年龄69.2±11.6岁；70.0%为女性）符合标准并纳入分析。X线片随访的平均时间为LRFN术后35.0±22.7个月。Cobb角平均每年进展0.54±3.03°，与已知的每年0.83±1.1°的自然进展率无显著差异。纳入的协变量（体重指数、LRFN侧别和去神经支配节段数）均与Cobb角平均每年进展率无显著相关性。
结论
我们的结果表明，LRFN对成人脊柱侧凸患者的Cobb角进展率没有明显影响。
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