■由于关节突关节关节病引起的慢性轴向下腰痛最好通过腰椎内侧支传导阻滞(MBB)进行诊断。然而,MBB用于选择腰椎射频神经切断术(RFN)患者的模式存在争议.某些Medicare局部承保范围测定(LCD)接受用于诊断腰椎关节疼痛的双重诊断性腰椎MBB,其疼痛缓解程度至少≥80%,可作为选择患者进行治疗腰椎关节关节疼痛的RFN方法。然而,一些人认为双重诊断MBB和≥80%疼痛缓解阈值在临床实践中缺乏实用性,考虑到那些从MBB1进展到MBB2的人将从MBB2流向RFN而不会失败。
■务实的回顾性临床审计。
■双重诊断腰椎MBB和≥80%疼痛改善诊断阈值的临床实践是否会降低MBB1和MBB2后患者的RFN资格?
■使用双重诊断腰椎MBB和≥80%疼痛改善诊断阈值,90/167(54%,95%CI46-61%)患者成功从MBB1进展到MBB2。在这90名患者中,66例患者(73%,95%CI64-82%)成功从MBB2进展到RFN。MBB1和MBB2都影响了77/167的进展资格(46%,95%CI39-54%)患者和24/90患者(27%,95%CI18-36%),分别。另一个子队列分析包括来自≥80%疼痛缓解队列的所有患者,那些在提供者的判断下进展并缓解了50-79%的患者显示,124/167名患者(74%,95%CI68-81%)成功从MBB1进展到MBB2。在这124名患者中,99名患者(80%,95%CI73-87%)从MBB2进展到RFN。在这个宽松的标准队列中,MBB1和MBB2影响43/167患者的进展资格(26%,95%CI19-32%)和25/124例患者(20%,95%CI13-27%),分别。
■MBB1和MBB2均使用双MBB过滤患者进展为腰椎RFN,疼痛缓解标准≥80%。当使用更宽松的疼痛缓解选择标准时,这也是正确的。与单一MBB和≥80%疼痛改善标准相比,作为选择范例的双重MBB和≥80%疼痛改善标准导致的腰椎RFN的一半。理论上,更严格的选择范式治疗更少的患者,但暴露于不必要的RFN更少,而更宽松的选择范式治疗更多的患者,但暴露于不必要的RFN更多.
UNASSIGNED: Chronic axial low back pain due to zygapophysial joint arthropathy is best diagnosed via lumbar medial branch block (MBB). However, the paradigm by which MBB is used to select patients for lumbar radiofrequency neurotomy (RFN) is contested. Dual diagnostic lumbar MBB with a minimum of ≥80% pain relief to diagnose lumbar zygapophysial joint pain are accepted by some Medicare Local Coverage Determination (LCD) as the method for selecting patients for RFN for the management of lumbar zygapophysial joint pain. However, some argue that dual diagnostic MBB and the ≥80% pain relief threshold lack utility in clinical practice, given that those that progress from MBB1 to MBB2 will then flow from MBB2 to RFN without fail.
UNASSIGNED: Pragmatic retrospective clinical audit.
UNASSIGNED: Does clinical practice of dual diagnostic lumbar MBBs and an ≥80% pain improvement diagnostic threshold reduce patient eligibility for RFN after both MBB1 and MBB2?
UNASSIGNED: Using dual diagnostic lumbar MBBs and an ≥80% pain improvement diagnostic threshold, 90/167 (54%, 95% CI 46-61%) patients successfully progressed from MBB1 to MBB2. Of those 90 patients, 66 patients (73%, 95% CI 64-82%) successfully progressed from MBB2 to RFN. Both MBB1 and MBB2 impacted the eligibility of the progression of 77/167 (46%, 95% CI 39-54%) patients and 24/90 patients (27%, 95% CI 18-36%), respectively. An additional sub-cohort analysis which included all the patients from the ≥80% pain relief cohort, and those who progressed at the discretion of the providers with 50-79% relief revealed that 124/167 patients (74%, 95% CI 68-81%) successfully progressed from MBB1 to MBB2. Of those 124 patients, 99 patients (80%, 95% CI 73-87%) progressed from MBB2 to RFN. In this laxer criteria cohort, MBB1 and MBB2 impacted the eligibility of the progression of 43/167 patients (26%, 95% CI 19-32%) and 25/124 patients (20%, 95% CI 13-27%), respectively.
UNASSIGNED: MBB1 and MBB2 both filtered patients from progression to lumbar RFN using dual MBBs with an ≥80% pain relief criteria. It also held true when using a more relaxed pain relief selection criterion as well. Dual MBB\'s and ≥80% pain improvement criteria as a selection paradigm led to half as many lumbar RFNs being performed when compared to a single MBB and ≥80% pain improvement criteria. In theory, a more rigid selection paradigm treats less patients but exposes fewer to unnecessary RFNs while a laxer selection paradigm treats more patients but exposes more to unnecessary RFNs.