Revel M, Poiraudeau S, Auleley G R, Payan C, Denke A, Nguyen M, Chevrot A, Fermanian J
Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, Université René Descartes, Paris, France.
Spine (Phila Pa 1976). 1998 Sep 15;23(18):1972-6; discussion 1977. doi: 10.1097/00007632-199809150-00011.
Prospective randomized study to compare the efficacy of facet joint injection with lidocaine and facet joint injection with saline in two groups of patients with low back pain, with and without clinical criteria that were determined in a previous study to implicate the facet joint as the primary source of the pain.
To assess the efficacy of single facet joint anesthesia versus placebo (saline injections) and to determine clinical criteria that are predictive of significant relief of LBP after injection.
There is no syndrome that discriminates between lower back pain caused by facet joint and that caused by other structures. Single or double facet joint anesthesia, and single photon emission computed tomography are expensive and time-consuming procedures for selecting patients in controlled clinical trials with large populations.
Results of a previous study showed that seven clinical characteristics were more frequent in patients who responded to facet joint anesthesia than in those who did not. In the current study, a group of 43 patients with lower back pain who met at least five criteria were compared with 37 patients who met fewer criteria. Patients randomly received injection of either lidocaine or saline into the lower facet joints. The result was considered positive if more than 75% pain relief was determined by visual analog scale. The patient, the radiologist, and the investigator were blinded. An analysis of variance was used to seek an interaction between clinical group effect and injection effect, and logistic regression analysis to select the best set of variables that would be predictive of minimum pain relief of 75% after the injection.
There was a significant interaction between clinical group and injection effect (P = 0.003). In patients with back pain, lidocaine provided greater lower-back pain relief than saline (P = 0.01). Lidocaine also-provided greater pain relief in the back pain group than in the nonpain group (P = 0.02). The presence of five among seven variables (age greater than 65 years and pain that was not exacerbated by coughing, not worsened by hyperextension, not worsened by forward flexion, not worsened when rising from flexion, not worsened by extension-rotation, and well-relieved by recumbency), always including the last item, distinguished 92% of patients responding to lidocaine injection and 80% of those not responding in the lidocaine group.
A set of five clinical characteristics can be used in randomized studies to select lower back pain that will be well relieved by facet joint anesthesia. These characteristics should not, however, be considered as definite diagnostic criteria of lower back pain originating from facet joints.
前瞻性随机研究，比较利多卡因小关节注射与生理盐水小关节注射在两组腰痛患者中的疗效，这两组患者有无在前一项研究中确定的表明小关节为主要疼痛来源的临床标准。
评估单小关节麻醉与安慰剂（生理盐水注射）的疗效，并确定预测注射后腰痛显著缓解的临床标准。
目前尚无综合征可区分由小关节引起的下腰痛与由其他结构引起的下腰痛。在大规模人群的对照临床试验中，单或双小关节麻醉以及单光子发射计算机断层扫描对于选择患者而言，成本高且耗时。
一项先前研究的结果显示，对小关节麻醉有反应的患者中，七种临床特征比无反应的患者更常见。在本研究中，将一组43例至少符合五项标准的下腰痛患者与37例符合标准较少的患者进行比较。患者被随机向下位小关节注射利多卡因或生理盐水。如果视觉模拟量表显示疼痛缓解超过75%，则结果被视为阳性。患者、放射科医生和研究者均不知情。采用方差分析来寻找临床组效应与注射效应之间的相互作用，并采用逻辑回归分析来选择能预测注射后最小疼痛缓解率达75%的最佳变量集。
临床组与注射效应之间存在显著的相互作用（P = 0.003）。在腰痛患者中，利多卡因比生理盐水能更好地缓解下腰痛（P = 0.01）。利多卡因在腰痛组中也比非疼痛组能更好地缓解疼痛（P = 0.02）。七个变量（年龄大于65岁、咳嗽时疼痛不加重、过伸时疼痛不加重、前屈时疼痛不加重、从屈曲位起身时疼痛不加重、伸展旋转时疼痛不加重、卧位时疼痛明显缓解）中出现五个，且始终包括最后一项，可区分出利多卡因注射组中92%有反应的患者和80%无反应的患者。
一组五项临床特征可用于随机研究，以选择能通过小关节麻醉得到良好缓解的下腰痛患者。然而，这些特征不应被视为源自小关节的下腰痛的确切诊断标准。
