背景:慢性轴性脊柱疼痛是致残的主要原因之一。文献表明,腰背和颈部疼痛以及肌肉骨骼疾病的支出继续增加,不仅有残疾,而且随着成本的增加,占各种疾病类别中最高的数量。根据目前使用受控诊断块的文献,面关节,神经根硬脑膜,和骶髂关节已被证明是脊柱疼痛的潜在来源。轴向脊柱疼痛的治疗小关节介入方式包括射频神经切开术,治疗性关节突关节神经阻滞,和治疗性关节内注射。
目的:本系统综述和荟萃分析的目的是评估小关节神经阻滞作为治疗小关节起源的慢性轴性脊柱疼痛的有效性。
方法:使用系统评价和荟萃分析(PRISMA)清单的首选报告项目对随机对照试验(RCT)和观察性研究进行系统评价和荟萃分析。
方法:综述了关于小关节神经阻滞治疗中轴性脊柱疼痛的现有文献。使用的质量评估标准是Cochrane审查标准,以评估偏差风险,干预性疼痛管理技术-用于随机治疗试验的可靠性和偏见风险评估(IPM-QRB)的质量评估,和介入疼痛管理技术-非随机研究的可靠性和风险评估的质量评估(IPM-QRBNR)。证据根据建议的分级进行分级,评估,发展,和评估(等级)评估标准。证据水平基于最佳证据综合,并将定性证据从I级修改为V级。从1966年至2023年7月,对多个数据库进行了全面的文献检索,包括手动检索已知评论文章的参考书目。将纳入研究的质量评估和最佳证据综合纳入定性和定量证据综合。
方法:主要结局指标是在至少3个月内,患者的显著缓解和功能改善超过50%的比例。救济的持续时间分为短期(少于6个月)和长期(超过6个月)。
结果:这项评估确定了8项高质量和1项中等质量的随机对照试验,以及8项高质量和4项中等质量的非随机研究,其中应用了脊髓小关节神经阻滞作为治疗方式。然而,根据建议的分级,评估,发展和评价(等级)评估,21项研究中只有3项显示出高水平的证据和临床适用性,11项研究显示中等程度的GRADE证据和临床适用性。
结论:尽管文献很少被认为是主要的缺点。根据建议的分级,评估发展,和评估(等级)评估,21项研究中只有3项显示高水平的证据和临床适用性.
结论:基于本系统综述和荟萃分析,对9项随机对照研究和12项非随机研究,证据为II级,推荐中度至重度治疗性关节突关节神经阻滞治疗脊柱小关节疼痛.
Chronic axial spinal pain is one of the major causes of disability. Literature shows that spending on low back and neck pain and musculoskeletal disorders continues to escalate, not only with disability, but also with increasing costs, accounting for the highest amount of various disease categories. Based on the current literature utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been shown as potential sources of spinal pain. Therapeutic facet joint interventional modalities of axial spinal pain include radiofrequency neurotomy, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections.
The objective of this systematic
review and meta-analysis is to evaluate the effectiveness of facet joint nerve blocks as a therapeutic modality in managing chronic axial spinal pain of facet joint origin.
A systematic
review and meta-analysis of randomized controlled trials (RCTs) and observational studies utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
The available literature on facet joint nerve blocks in axial spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane
review criteria to assess risk of bias, the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials, and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for nonrandomized studies. The evidence was graded according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment criteria. The level of evidence was based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. A comprehensive literature search of multiple databases from 1966 to July 2023, including manual searches of the bibliography of known
review articles was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into qualitative and quantitative evidence synthesis.
The primary outcome measure was the proportion of patients with significant relief and functional improvement of greater than 50% of at least 3 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).
This assessment identified 8 high-quality and one moderate quality RCTs and 8 high quality and 4 moderate quality non-randomized studies with application of spinal facet joint nerve blocks as therapeutic modalities. However, based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability, with 11 studies showing moderate levels of GRADE evidence and clinical applicability.
Despite the availability of multiple studies, the paucity of literature is considered as the major drawback. Based on Grading of Recommendations, Assessment Development, and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability.
Based on the present systematic
review and meta-analysis with 9 RCTs and 12 non-randomized studies, the evidence is Level II with moderate to strong recommendation for therapeutic facet joint nerve blocks in managing spinal facet joint pain.