影像引导下小关节疼痛注射治疗：来自欧洲肌肉骨骼放射学会和欧洲神经放射学会的循证德尔菲联合共识文件
Image-guided injections for facet joint pain: evidence-based Delphi conjoined consensus paper from the European Society of Musculoskeletal Radiology and European Society of Neuroradiology.
作者信息
Sconfienza Luca Maria, Dalili Danoob, Adriaensen Miraude, Albano Domenico, Allen Georgina, Aparisi Gomez Maria Pilar, Aringhieri Giacomo, Arrigoni Francesco, Bazzocchi Alberto, Oliveira Castro Miguel, Cazzato Roberto Luigi, De Dea Miriam, De Vivo Aldo Eros, Drakonaki Elena, Facal de Castro Fernando, Filippiadis Dimitrios, Fritz Jan, Gil Inês, Gitto Salvatore, Gruber Hannes, Gupta Harun, Isaac Amanda, Klauser Andrea S, Le Corroller Thomas, Loizides Alexander, Marsico Salvatore, Mauri Giovanni, McNally Eugene, Melaki Kalliopi, Messina Carmelo, Mirón Mombiela Rebeca, Olchowy Cyprian, Orlandi Davide, Moutinho Ricardo, Picasso Riccardo, Prakash Mahesh, Theumann Nicolas, Vasilevska Nikodinovska Violeta, Vassalou Evangelia E, Vucetic Jelena, Wilson David, Zaottini Federico, Zappia Marcello, Zini Chiara, Snoj Žiga
机构信息
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
出版信息
Eur Radiol. 2025 May 8. doi: 10.1007/s00330-025-11651-9.
OBJECTIVES
To perform a Delphi-based consensus on published evidence on image-guided injections for facet joint pain (FJP) and provide clinical indications.
METHODS
We report the results of an evidence-based Delphi consensus of 38 experts from the European Society of Musculoskeletal Radiology and the European Society of Neuroradiology, who reviewed the published literature for evidence on image-guided injections for FJP. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when ≥ 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the consensus were used to write the paper.
RESULTS
Twenty statements on image-guided FJP treatment have been drafted. Eighteen statements received strong consensus, while two received broad consensus. Three statements reached the highest level of evidence, all of them regarding the lumbar spine. All radiological methods are used for image-guided injections for FJP, and regardless of the radiological method used, all show good safety and efficacy. Facet joint injections and medial branch blocks are used in all spinal regions to treat FJP, and both show similar clinical outcomes. Advanced technological solutions have been studied in the field of lumbar FJP; however, the level of evidence for these is low.
CONCLUSION
Despite promising results reported by published papers on image-guided injections for FJP, there is still a lack of evidence on injection efficacy, appropriateness of imaging methods, and optimal medication.
KEY POINTS
Question Image-guided injections to treat facet joint pain (FJP) are performed throughout the spine; however, the highest level of evidence exists for the lumbar spine. Findings Regardless of the imaging method used, image-guided injections for facet joint pain treatment are safe, with only minor adverse events in rare cases. Clinical relevance All imaging methods are used for injection guidance to treat FJP, each with advantages and disadvantages. These statements on image-guided injections for FJP provide a concise and up to date overview on the topic, serving as a list of clinical indications.
目的
基于德尔菲法就已发表的关于小关节疼痛（FJP）影像引导注射的证据达成共识，并提供临床指征。
方法
我们报告了来自欧洲肌肉骨骼放射学会和欧洲神经放射学会的38位专家基于循证德尔菲法达成的共识结果，这些专家查阅了已发表的文献，以获取关于FJP影像引导注射的证据。专家们起草了一份陈述清单，并根据牛津循证医学中心的证据水平对其进行分级。当≥95%的专家同意该陈述时，共识被认为是强烈的；当>80%但<95%的专家同意时，共识被认为是广泛的。共识结果被用于撰写本文。
结果
已起草了20条关于影像引导FJP治疗的陈述。18条陈述获得了强烈共识，2条获得了广泛共识。3条陈述达到了最高证据水平，均与腰椎有关。所有放射学方法都用于FJP的影像引导注射，无论使用何种放射学方法，均显示出良好的安全性和有效性。小关节注射和内侧支阻滞用于所有脊柱区域治疗FJP，两者显示出相似的临床结果。在腰椎FJP领域已经研究了先进的技术解决方案；然而，这些方案的证据水平较低。
结论
尽管已发表的关于FJP影像引导注射的论文报告了有前景的结果，但在注射疗效、成像方法的适用性和最佳药物方面仍然缺乏证据。
关键点
问题 影像引导注射治疗小关节疼痛（FJP）在整个脊柱中都有应用；然而，腰椎的证据水平最高。发现 无论使用何种成像方法，影像引导注射治疗小关节疼痛都是安全的，在极少数情况下仅有轻微不良事件。临床意义 所有成像方法都用于注射引导以治疗FJP，每种方法都有优缺点。这些关于FJP影像引导注射的陈述提供了关于该主题的简洁且最新的概述，可作为临床指征清单。
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