Department of Orthopedic Surgery, E-DA Hospital, Kaohsiung, Taiwan.
School of Medicine, I-Shou University, Kaohsiung, Taiwan.
Sci Rep. 2024 Nov 19;14(1):28563. doi: 10.1038/s41598-024-79181-w.
Neck pain due to cervical facet joint pain has a prevalence of 36-60% in chronic neck pain. Pulsed radiofrequency for such pain has been verified. After proper patient selection, pulsed radiofrequency of the cervical facet joints provide long-term pain relief in a routine clinical setting. In the patient selection, clinical and sagittal alignment parameters are rarely discussed for the outcome. In the present study, we analyzed the factors from the clinical data and sagittal alignment parameters and investigated the associated predictors of pulsed radiofrequency for cervical facet joint pain. There were 204 patients with cervical facet joint pain who received a medial branch block and pulsed radiofrequency between 2015 and 2020 after excluding patients with neurological symptoms and other confounding factors. The patients were classified into good and poor outcome groups based on the improvement of the pain score(visual analog scale). Clinical and radiological data were analyzed. Multivariable logistic model showed that the predictors were cervical lordosis including two methods (odds ratio [OR] 0.92, 95% confidence interval [CI]: 0.89-0.96 for C2-C7 Cobb angle; OR 0.91, 95% CI: 0.88-0.95 for the angle measured by the Jackson method), ossification of the nuchal ligament, number of diseased facet joints, anterior cervical discectomy with fusion, and adjacent facet joint after anterior cervical discectomy with fusion. With the results, we demonstrated that the outcome were related to cervical lordosis including two methods, formation of ossification of nuchal ligament, the number of diseased facet joints, post anterior cervical discectomy with fusion, and adjacent facet joint post anterior cervical discectomy with fusion. The corresponding optimal cutoff for discriminating a poor outcome was 7° for the C2-C7 Cobb angle and - 2° for the angle measured using the Jackson method.
颈椎小关节源性颈痛的患病率为慢性颈痛的 36-60%。脉冲射频已被证实对此类疼痛有效。在适当的患者选择后，颈椎小关节的脉冲射频在常规临床环境中提供长期的疼痛缓解。在患者选择中，临床和矢状面排列参数很少被讨论用于预测结果。在本研究中，我们分析了临床数据和矢状面排列参数中的因素，并研究了脉冲射频治疗颈椎小关节疼痛的相关预测因素。2015 年至 2020 年间，排除有神经症状和其他混杂因素的患者后，共有 204 例颈椎小关节痛患者接受了内侧支阻滞和脉冲射频治疗。根据疼痛评分（视觉模拟评分）的改善，将患者分为疗效良好和疗效不佳两组。分析了临床和影像学资料。多变量逻辑模型显示，预测因素包括颈椎前凸度，包括两种方法（C2-C7 Cobb 角的优势比 [OR] 0.92，95%置信区间 [CI]：0.89-0.96；Jackson 法测量的角度的 OR 0.91，95%CI：0.88-0.95）、项韧带骨化、病变小关节数量、颈椎前路椎间盘切除融合术和颈椎前路椎间盘切除融合术后相邻小关节。结果表明，疗效与颈椎前凸度（包括两种方法）、项韧带骨化形成、病变小关节数量、颈椎前路椎间盘切除融合术后、颈椎前路椎间盘切除融合术后相邻小关节有关。区分不良预后的最佳截断值分别为 Cobb 角 7°和 Jackson 法测量的角度-2°。
