Derby Richard, Vorobeychik Yakov, Schneider Byron J, McCormick Zachary L
Spinal Diagnostics and Treatment Center, Daily City, Ca, USA.
Penn State Milton S. Hershey Medical Center, Penn State College of Medicine. Department of Anesthesiology & Perioperative Medicine, Hershey, PA, USA.
Interv Pain Med. 2022 Mar 25;1(2):100085. doi: 10.1016/j.inpm.2022.100085. eCollection 2022 Jun.
No prior studies have investigated an assumed advantage of creating a radiofrequency strip lesion for posterior element spinal axial pain using a two-needle technique (TNT) compared to a one-needle technique (ONT) that creates a single ovoid lesion. We explore the relationship of TNT compared to ONT on the magnitude and duration of pain relief following thoracic medial branch neurotomy (TMBN).
This study is a retrospective audit of consecutive patients treated with TMBN at a single site and interventionalist over ten years (2007-2017). All patients had undergone TMBN after failed conservative care and, with few exceptions, patient-reported ≥ 70% pain relief after thoracic medial branch block (TMBB). All patients had TMBN performed with a medial to lateral (MLA) radiofrequency cannula approach using either an ONT or TNT technique. We used parametric and nonparametric statistics and three levels of case analysis to assess for intergroup differences.
Thirty-five consecutive patients underwent their primary TMBN, and two underwent both on a subsequent repeat using the MLA approach, 19 using the ONT, 18 using the TNT. The TNT group had clinically and statistically greater pain relief magnitude and duration than the ONT subgroup. The difference resulted in non-overlapping 95% confidence intervals for both percent pain relief and duration of pain relief using three levels of case analysis.
The comparison of TMBN techniques demonstrates a statistically significant separation of TNT to ONT sample mean values for magnitude and duration of pain relief when using TNT compared to ONT for TMBN using an MLA.
既往尚无研究比较使用双针技术（TNT）与单针技术（ONT）创建射频条带损伤治疗脊柱后部轴向疼痛的假定优势，单针技术创建的是单个椭圆形损伤。我们探讨了在胸椎内侧支神经切断术（TMBN）后，TNT与ONT在疼痛缓解程度和持续时间方面的关系。
本研究是对在单一地点由一名介入医生在十年间（2007 - 2017年）连续接受TMBN治疗的患者进行的回顾性审计。所有患者在保守治疗失败后接受了TMBN，除少数例外，患者报告在胸椎内侧支阻滞（TMBB）后疼痛缓解≥70%。所有患者均采用从内侧到外侧（MLA）的射频套管针方法，使用ONT或TNT技术进行TMBN。我们使用参数和非参数统计以及三个层次的病例分析来评估组间差异。
35例连续患者接受了首次TMBN，2例在随后的重复治疗中均采用MLA方法，19例使用ONT，18例使用TNT。TNT组在临床和统计学上的疼痛缓解程度和持续时间均高于ONT亚组。使用三个层次的病例分析，在疼痛缓解百分比和疼痛缓解持续时间方面，差异导致95%置信区间不重叠。
TMBN技术的比较表明，如果在TMBN中使用MLA时，与ONT相比，TNT在疼痛缓解程度和持续时间的样本均值上在统计学上有显著差异。
