Amatto Alycia, Burnham Taylor, Teramoto Masaru, Burnham Robert
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
University of Utah, Department of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA.
Interv Pain Med. 2023 Aug 8;2(3):100271. doi: 10.1016/j.inpm.2023.100271. eCollection 2023 Sep.
The Sacroiliac Joint (SIJ) accounts for 10-27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences.
To assess the effectiveness and outcome success predictors of SIJ RFN at three months.
DESIGN/METHODS: Data of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire - Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50-79% LBB/LBB, 50-79% IA/LBB, >79% LBB, and 50-79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral).
Of the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34-11.43; = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates ( > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ ( = 0.034, 0.020, and 0.002, respectively).
SIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.
骶髂关节（SIJ）导致的下背部疼痛占比为10%-27%。射频神经切断术（RFN）常用于治疗顽固性疼痛。其治疗效果存在差异，可能与患者选择及手术技术差异有关。
评估骶髂关节射频神经切断术在三个月时的有效性及预后成功预测因素。
设计/方法：从一位物理治疗师2016年至2021年介入性疼痛治疗实践的电子病历中提取接受骶髂关节射频神经切断术患者的数据。提取的数据包括以下结局变量：数字评定量表（NRS）降低≥2分[最小临床重要差异MCID-2]、NRS降低≥50%，以及疼痛残疾与生活质量问卷-脊柱版（PDQQ-S）降低≥17分[MCID]。预测变量包括阻滞类型[>79%腰大肌阻滞/腰大肌阻滞、>79%髂腹下神经阻滞/腰大肌阻滞、50%-79%腰大肌阻滞/腰大肌阻滞、50%-79%髂腹下神经阻滞/腰大肌阻滞、>79%腰大肌阻滞和50%-79%腰大肌阻滞]和套管类型/配置[16g/纵向、三叉戟双极/垂直和18g四极/垂直]。数据分析包括描述性统计和采用优势比（OR）的逻辑回归。逻辑回归模型中纳入的协变量包括年龄、性别和侧别（右侧、左侧和双侧）。
本研究分析的128例患者中（20.8%为男性；年龄60.4±14.4岁），66.9%的患者NRS达到MCID-2，53.9%的患者NRS降低≥50%，50%的患者PDQQ-S降低≥17分。18g四极/垂直技术在NRS中达到MCID-2的几率约为16g/纵向技术的四倍（OR=3.91；95%CI=1.34-11.43；P=0.013）。在调整套管类型和其他协变量后，阻滞类型与任何结局变量均无显著相关性（P>0.05）。年龄较小与NRS达到MCID-2、NRS降低≥50%以及PDQQ降低≥17分显著相关（分别为P=0.034、0.020和0.002）。
骶髂关节射频神经切断术在三个月时能有效减轻大多数患者的疼痛并改善功能。四极/垂直技术和较年轻的年龄可预测骶髂关节射频神经切断术治疗成功，而阻滞类型则不能。
