腰背痛是全球因残疾而失去多年的主要原因。大约15%至45%的慢性下背痛是由于小关节关节病。目前,没有大规模的回顾性研究对接受内侧支射频消融(RFA)治疗小关节关节病的患者成功的长期临床预测因素进行调查.
探讨腰椎小关节RFA术后1年随访成功和失败的临床因素。
临床数据来自国际疾病分类(ICD)-诊断为腰椎病的500名连续患者。在多个时间点记录接受腰椎内侧支RFA手术的患者的VAS疼痛评分,为期1年的随访。反应者定义为VAS评分与术前VAS评分相比改善≥30%。对于我们的初步分析,进行回归分析以确定应答者状态和患者特征之间的关联,包括年龄,性别,体重指数(BMI),激素的使用,鸦片剂量,和多个时间点的吸烟史,为期1年的随访。
总共500名患者被纳入研究。在RFA后的1年随访中,反应者状态与较低的阿片类药物使用率相关(43.22%与55.76%,优势比0.60[95%置信区间(CI)0.40至0.92],P=0.018),口服吗啡当量的术前阿片类药物消费量较低(10.16±16.02vs.14.67±20.65,β-4.50[95%CI-8.57至-0.44],P=0.030),和较高的前VAS疼痛评分(6.36±2.17vs.5.85±2.17,β0.50[95%CI0.06至0.95],P=0.028)。应答者状态和年龄之间没有显著关联,性别,BMI,激素的使用,和1年随访时的吸烟史。
我们的结果表明,患者处方阿片类药物,特别是在较高的剂量下,RFA治疗面部源性疼痛1年后,疼痛缓解可能较少。此外,术前VAS疼痛评分较高的患者在1年时更有可能出现阳性反应.
Low back pain is the leading cause of years lost to disability worldwide. Approximately 15% to 45% of chronic low back pain is due to facet joint arthropathy. Currently, no large-scale retrospective studies have investigated long-term clinical predictors of success in individuals receiving radiofrequency ablation (RFA) of the medial branches for facet joint arthropathy.
To determine the clinical factors associated with success and failure of RFA of lumbar facet joints at 1-year follow-up.
Clinical data were gathered from 500 consecutive patients with an International Classification of Diseases (ICD)-10 diagnosis of lumbar spondylosis. VAS pain scores for patients undergoing lumbar medial branch RFA procedures were recorded at multiple time points, up to the 1-year follow-up visit. A responder was defined as having ≥30% improvement in VAS score from the pre-procedural VAS score. For our primary analysis, regression analysis was conducted to identify associations between responder status and patient characteristics, including age, gender, body mass index (BMI), hormone use, opiate dose, and smoking history at multiple time points, up to the 1-year follow-up visit.
A total of 500 patients were included in the study. At the 1-year post-RFA follow-up visit, responder status was associated with a lower rate of prior opioid use (43.22% vs. 55.76%, odds ratio 0.60 [95% confidence interval (CI) 0.40 to 0.92], P = 0.018), lower pre-procedural opioid consumption in oral morphine equivalents (10.16 ± 16.02 vs. 14.67 ± 20.65, β -4.50 [95% CI -8.57 to -0.44], P = 0.030), and a higher pre-VAS pain score (6.36 ± 2.17 vs. 5.85 ± 2.17, β 0.50 [95% CI 0.06 to 0.95], P = 0.028). There were no significant associations between responder status and age, gender, BMI, hormone use, and smoking history at the 1-year follow-up visit.
Our results suggest that patients prescribed opioids, particularly at higher dosages, may find less pain relief 1 year following RFA for facetogenic pain. Additionally, patients with higher pre-procedural VAS pain scores may be more likely to have a positive response at 1 year.