两种常见内侧支阻滞模式选择的患者中，颈椎内侧支射频消融治疗慢性小关节综合征有效性的比较。
A comparison of the effectiveness of cervical medial branch radiofrequency ablation for chronic facet joint syndrome in patients selected by two common medial branch block paradigms.
作者信息
Burnham Taylor R, Clements Nathan, Conger Aaron, Kuo Keith, Lider Joshua, Caragea Marc, Kendall Richard, Cunningham Shellie, Meiling James B, Teramoto Masaru, McCormick Zachary L
机构信息
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
出版信息
Interv Pain Med. 2022 Apr 8;1(2):100091. doi: 10.1016/j.inpm.2022.100091. eCollection 2022 Jun.
BACKGROUND
Cervical medial branch radiofrequency ablation (CMBRFA) is effective when patients are selected by dual medial branch blocks (MBBs). SIS guidelines recommend 100% pain improvement after dual comparative MBBs before CMBRFA; however, our prior investigation showed similar outcomes in those selected by a lesser strict paradigm.
OBJECTIVE
Compare pain and patient impression of improvement after CMBRFA in individuals stratified by a less stringent (80-99%) dual MBB response than those selected by the 100% criteria.
DESIGN
Cross-sectional study.
METHODS
Follow-up was conducted via standardized telephone survey at ≥6 months post-CMBRFA to obtain Numerical Rating Scale (NRS) pain and Patient Global Impression of Change (PGIC) scores. Primary and secondary outcomes were within-group and between-group differences in the proportions of patients reporting ≥50% NRS score reduction and PGIC scores.
RESULTS
Medical records of 195 consecutive patients were reviewed; 100 individuals were analyzed. 48% (95% CI 35-61%) and 52% (95% CI 37-67%) of the 80-99% and 100% MBB groups, reported ≥50% pain reduction at ≥6 months post-CMBRFA. 74% (95% CI 63-85%) and 67% (95% CI 52-81%) of the 80-99% and 100% MBB groups reported a PGIC score consistent with "improved" or "very much improved." There were no significant between-group differences in any outcome at any time point.
CONCLUSIONS
We observed similar rates of pain relief and global improvement after CMBRFA in patients selected by dual MBBs with ≥80% symptom relief versus 100% relief. This provides evidence that a more practical criteria, compared to a more strict selection paradigm, may result in similar clinical outcomes.
背景
当通过双侧内侧支阻滞（MBB）选择患者时，颈椎内侧支射频消融术（CMBRFA）是有效的。SIS指南建议在CMBRFA之前，双侧对比MBB后疼痛改善100%；然而，我们之前的研究表明，在那些通过不太严格的标准选择的患者中，结果相似。
目的
比较CMBRFA后，按照双侧MBB反应低于严格标准（80-99%）分层的个体与按照100%标准选择的个体的疼痛情况和患者对改善的印象。
设计
横断面研究。
方法
在CMBRFA后≥6个月通过标准化电话调查进行随访，以获得数字疼痛评分量表（NRS）疼痛评分和患者总体印象变化（PGIC）评分。主要和次要结局是报告NRS评分降低≥50%和PGIC评分的患者比例的组内和组间差异。
结果
回顾了195例连续患者的病历；分析了100例个体。在CMBRFA后≥6个月，80-99%和100%MBB组分别有48%（95%CI 35-61%）和52%（95%CI 37-67%）的患者报告疼痛减轻≥50%。80-99%和100%MBB组分别有74%（95%CI 63-85%）和67%（95%CI 52-81%）的患者报告PGIC评分符合“改善”或“非常改善”。在任何时间点，任何结局的组间差异均无统计学意义。
结论
我们观察到，在通过双侧MBB选择的患者中，症状缓解≥80%与100%缓解的患者在CMBRFA后的疼痛缓解率和总体改善率相似。这提供了证据，表明与更严格的选择标准相比，更实用的标准可能会导致相似的临床结果。
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