预测骶外侧支射频神经切断术后成功治疗结果的最佳阻滞选择模式是什么？一项真实世界队列研究。
What is the optimal block selection paradigm for predicting a successful treatment outcome following sacral lateral branch radiofrequency neurotomy? A real-world cohort study.
作者信息
Smolinski Katharine A, Radlicz Christopher, Sen Hasan, Cooper Amanda N, Martin Brook, Amatto Alycia, Przybysz Allison Glinka, Burnham Robert, Conger Aaron M, McCormick Zachary L, Burnham Taylor R
机构信息
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Division of Physical Medicine and Rehabilitation, Washington University in Saint Louis, Saint Louis, MO, USA.
出版信息
Interv Pain Med. 2025 Jun 2;4(2):100599. doi: 10.1016/j.inpm.2025.100599. eCollection 2025 Jun.
BACKGROUND
Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment success following SLBRFN.
METHODS
In this retrospective cohort study, consecutive patients from two Canadian musculoskeletal pain management clinics who underwent SLBRFN over a 6-year period (2016-2022) were identified by electronic medical record. Patients were categorized according to several prognostic block paradigms based on number of blocks (single vs. dual), block type (lateral branch block [LBB] vs. intra-articular block [IAB]), and subsequent percentage of pain relief. Six block criteria were established: 1 = LBB/LBB≥80 %; 2 = IAB/LBB≥80 %; 3 = LBB/LBB 50-79 %; 4 = IAB/LBB 50-79 %; 5 = LBB≥80 %; 6 = LBB 50-79 %. Treatment success was assessed at three months post-SLBRFN using two criteria: (1) the primary study outcome of ≥50 % numerical rating scale (NRS) pain reduction and (2) a secondary outcome of Pain Disability Quality-of-Life Questionnaire (PDQQ) score improvement by the minimal clinically important difference (MCID). Logistic regression analyses evaluated the association between block criteria and treatment success following SLBRFN.
RESULTS
281 consecutive patients (75.1 % female, 61.8 ± 14.2 years of age, BMI 29.4 ± 6.6 kg/m) were included. Cohort success rates for pain and functional improvement were 43.4 % (95 % CI: 37.8-49.3) and 46.6 % (95 % CI: 40.9-52.5), respectively. After adjusting for demographics and cannula type/SLBRFN technique, none of the odds ratios for the six prognostic block paradigms showed statistical significance.
CONCLUSION
Nearly 50 % of patients who underwent SLBRFN reported clinically significant improvement in pain and disability at three months post-procedure, regardless of prognostic block selection criteria. These results suggest that multiple block strategies may determine eligibility for SLBRFN.
背景
骶外侧支射频神经切断术（SLBRFN）后的疗效可能取决于患者选择标准；然而，常用标准差异很大。完善SLBRFN的选择标准可能会改善治疗效果。本研究调查了基于预后阻滞的常见选择标准以及SLBRFN后的治疗成功率。
方法
在这项回顾性队列研究中，通过电子病历识别了来自加拿大两家肌肉骨骼疼痛管理诊所的连续患者，这些患者在6年期间（2016 - 2022年）接受了SLBRFN。根据阻滞数量（单次与两次）、阻滞类型（外侧支阻滞[LBB]与关节内阻滞[IAB]）以及随后的疼痛缓解百分比等几种预后阻滞模式对患者进行分类。建立了六个阻滞标准：1 = LBB/LBB≥80%；2 = IAB/LBB≥80%；3 = LBB/LBB 50 - 79%；4 = IAB/LBB 50 - 79%；5 = LBB≥80%；6 = LBB 50 - 79%。在SLBRFN后三个月使用两个标准评估治疗成功率：（1）主要研究结局为数字评定量表（NRS）疼痛减轻≥50%，（2）次要结局为疼痛残疾生活质量问卷（PDQQ）评分改善达到最小临床重要差异（MCID）。逻辑回归分析评估了阻滞标准与SLBRFN后治疗成功率之间的关联。
结果
纳入了281例连续患者（75.1%为女性，年龄61.8±14.2岁，BMI 29.4±6.6 kg/m）。队列中疼痛和功能改善的成功率分别为43.4%（95%CI：37.8 - 49.3）和46.6%（95%CI：40.9 - 52.5）。在对人口统计学和套管类型/SLBRFN技术进行调整后，六种预后阻滞模式的优势比均未显示出统计学意义。
结论
接受SLBRFN的患者中，近50%在术后三个月报告疼痛和残疾有临床显著改善，无论预后阻滞选择标准如何。这些结果表明，多种阻滞策略可能决定SLBRFN的适用性。
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