Fogarty Alexandra E, Buttner Jordan A, Duszynski Belinda, McKenna Michael J, Miller David C, Gonzalez-Cota Alan, Avila Arsenio, Vaynberg Eduard, Sheth Samir, Conger Aaron, Doan Lisa V, Ehsanian Reza
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
University of New Mexico School of Medicine, Albuquerque, NM, USA.
Interv Pain Med. 2025 May 9;4(2):100587. doi: 10.1016/j.inpm.2025.100587. eCollection 2025 Jun.
Facet joint degeneration is a known source of chronic axial low back pain, and intra-articular steroid injections (IASI) have been used as a treatment.
To systematically review the evidence of the effectiveness of fluoroscopically guided lumbar IASI for the treatment of lumbar facet joint pain.
The primary outcome was ≥50 % pain reduction at ≥ 1 month, measured by Visual Analog Scale and/or Numeric Rating Scale. Secondary outcomes included ≥30 % functional improvement on a validated functional scale. Studies including group mean improvements in pain/function without categorical reporting were also considered. Two reviewers independently screened Embase, Cochrane, PubMed Medline, Ovid Medline, Web of Knowledge, and Google Scholar. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and evidence quality was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).
Of the 701 publications screened, 21 met the inclusion criteria. Success rates for clinically significant pain reduction (≥50 % pain relief) ranged from 13 to 74 %, and functional improvement (≥30 % improvement) was 29 % at ≥ 1 month, based on only one study. Overall, mean improvement ranged from 11 to 59 % for pain relief and 8-58 % for function at ≥ 1 month. In the seven studies selecting patients with facet or medial branch blocks, success rates for clinically significant pain reduction (≥50 % pain relief) are reported as 13-74 % at ≥ 1 month. In this subgroup, mean pain improvement rates ranged from 23 to 67 % and functional improvement from 15 to 58 % at ≥ 1 month. According to GRADE, the overall quality of the evidence is very low due to the high risk of bias, study heterogeneity, and inconsistent methodologies.
DISCUSSION/CONCLUSION: Pragmatic and observational studies suggest IASI may reduce pain and disability, while sham-controlled trials have not demonstrated efficacy. Given the very low quality of evidence, the true effect of IASI is highly uncertain. Further high-quality, placebo-controlled studies using standardized diagnostic criteria are needed.
小关节退变是慢性轴性下腰痛的已知病因，关节内注射类固醇（IASI）已被用作一种治疗方法。
系统评价在透视引导下进行腰椎 IASI 治疗腰椎小关节疼痛有效性的证据。
主要结局指标为在≥1 个月时疼痛减轻≥50%，采用视觉模拟评分法和/或数字评分法进行测量。次要结局指标包括在经过验证的功能量表上功能改善≥30%。也纳入了那些报告了疼痛/功能方面组平均改善情况但未进行分类报告的研究。两名评价者独立检索了 Embase、Cochrane、PubMed 医学期刊数据库、Ovid 医学期刊数据库、Web of Knowledge 和谷歌学术。使用 Cochrane 偏倚风险工具评估偏倚风险，并使用推荐分级、评估、制定与评价（GRADE）对证据质量进行评价。
在筛选的 701 篇文献中，21 篇符合纳入标准。临床上显著减轻疼痛（疼痛缓解≥50%）的成功率在 13%至 74%之间，而基于仅一项研究，在≥1 个月时功能改善（改善≥30%）为 29%。总体而言，在≥1 个月时，疼痛缓解的平均改善率在 11%至 59%之间，功能改善率在 8%至 58%之间。在七项选择小关节或内侧支阻滞患者的研究中，报告在≥1 个月时临床上显著减轻疼痛（疼痛缓解≥50%）的成功率为 13%至 74%。在该亚组中，在≥1 个月时，平均疼痛改善率在 23%至 67%之间，功能改善率在 15%至 58%之间。根据 GRADE 标准，由于偏倚风险高、研究异质性和方法不一致，证据的总体质量非常低。
讨论/结论：实用和观察性研究表明 IASI 可能减轻疼痛和残疾，而假手术对照试验未证明其疗效。鉴于证据质量非常低，IASI 的真实效果高度不确定。需要进一步开展使用标准化诊断标准的高质量、安慰剂对照研究。
