Glinka Przybysz Allison, Galang Enrique, Sangio Christian A, Wirawan Christian, Cooper Amanda N, Amatto Alycia, Martin Brook, Burnham Robert, Conger Aaron M, McCormick Zachary L, Burnham Taylor R
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Interv Pain Med. 2025 Mar 19;4(1):100559. doi: 10.1016/j.inpm.2025.100559. eCollection 2025 Mar.
Considerable variability exists in the literature record regarding patient selection criteria for cervical medial branch radiofrequency neurotomy (CMBRFN). Few prior studies have assessed the correlation between different prognostic block paradigms and treatment outcomes for this procedure.
Examine the association between various prognostic block selection criteria and CMBRFN success rates.
Retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time CMBRFN between 2016 and 2022 with a three-tined cannula utilizing a perpendicular approach. Patients were categorized according to prognostic block paradigms (single vs. dual), block type (medial branch block [MBB] vs. intraarticular block [IAB]), and percentage pain relief after blocks. Six block criteria were established: 1 = MBB/MBB≥80 %; 2 = MBB/MBB 50-79 %; 3 = IAB/MBB≥80 %; 4 = IAB/MBB 50-79 %; 5 = MBB≥80 %; 6 = MBB 50-79 %. Treatment success was evaluated at 3 months post-CMBRFN as the proportion of participants with (1) ≥50 % NRS pain score reduction (the primary outcome) and (2) ≥17-point score decrease (the minimal clinically important difference [MCID]) on the Pain Disability Quality-of-Life Questionnaire - Spine (PDQQ-S). Logistic regression analyses were used to explore associations between block criteria and CMBRFN treatment success.
A total of 171 consecutive patients (58.5 % female; 58.0 ± 12.1 years of age; BMI 28.7 ± 6.0 kg/m) were included. 60.8 % (95%CI: 53.3-67.8 %) and 61.4 % (95%CI: 53.9-68.7 %) of patients reported ≥50 % NRS and ≥17-point PDQQ-S reduction, respectively. After controlling for demographic factors, there were no statistically significant differences in the odds of treatment success amongst individuals selected by various prognostic block paradigms.
Over 60 % of patients who underwent CMBRFN reported clinically significant magnitudes of improvement in pain and disability at three months post-CMBRFN, regardless of prognostic block selection criteria. These findings suggest that multiple block strategies might be employed to determine eligibility for CMBRFN. Larger, prospective studies including long-term outcome assessments are needed to further evaluate these findings.
关于颈椎内侧支射频神经切断术（CMBRFN）的患者选择标准，文献记录中存在相当大的差异。很少有先前的研究评估这种手术中不同预后阻滞模式与治疗结果之间的相关性。
研究各种预后阻滞选择标准与CMBRFN成功率之间的关联。
对来自加拿大两家肌肉骨骼疼痛管理诊所的连续患者进行回顾性队列研究，这些患者在2016年至2022年间年间年间首次接受使用三叉套管针垂直进针的CMBRFN。患者根据预后阻滞模式（单次与双次）、阻滞类型（内侧支阻滞[MBB]与关节内阻滞[IAB]）以及阻滞后疼痛缓解百分比进行分类。建立了六个阻滞标准：1 = MBB/MBB≥80%；2 = MBB/MBB 50 - 79%；3 = IAB/MBB≥80%；4 = IAB/MBB 50 - 79%；5 = MBB≥80%；6 = MBB 50 - 79%。在CMBRFN术后3个月评估治疗成功率，评估指标为（1）数字评分量表（NRS）疼痛评分降低≥50%（主要结局）以及（2）疼痛残疾生活质量问卷 - 脊柱版（PDQQ - S）评分降低≥17分（最小临床重要差异[MCID]）的参与者比例。采用逻辑回归分析来探讨阻滞标准与CMBRFN治疗成功率之间的关联。
共纳入171例连续患者（女性占58.5%；年龄58.0±12.1岁；体重指数28.7±6.0kg/m²）。分别有60.8%（95%置信区间：53.3 - 67.8%）和61.4%（95%置信区间：53.9 - 68.7%）的患者报告NRS降低≥50%以及PDQQ - S降低≥17分。在控制人口统计学因素后，不同预后阻滞模式选择的个体治疗成功几率没有统计学上的显著差异。
接受CMBRFN的患者中，超过60%在CMBRFN术后3个月报告疼痛和残疾有临床上显著的改善程度，无论预后阻滞选择标准如何。这些发现表明可以采用多种阻滞策略来确定CMBRFN的适应证。需要进行更大规模的前瞻性研究，包括长期结局评估，以进一步评估这些发现。
