背景:先前的研究报道,磁共振成像(MRI)和计算机断层扫描(CT)不能预测对小关节阻滞的反应。然而,小面关节内的单光子发射计算机断层扫描(SPECT)吸收已被证明与腰椎介入后的疼痛缓解相关。关于单光子发射计算机断层扫描/计算机断层扫描(SPECT/CT)对颈部疼痛的预测值的数据很少。
目的:本研究的目的是评估SPECT/CT在轴性颈痛患者中的应用,以确定可从诊断和治疗性小关节类固醇注射和/或内侧支传导阻滞/RFA治疗中获益的特定小关节。
方法:回顾性队列研究。
方法:2009年至2015年期间,在一个单一机构疼痛中心的一百七十九名患者患有颈部疼痛和SPECT/CT扫描。112名患者在兴趣水平上没有事先干预,并且符合纳入标准。
方法:在小平面干预后24小时内,在50%和80%阈值下疼痛减轻。小平面干预与SPECT/CT扫描最大摄取焦点的一致性。
方法:所有患者都被转诊到我们机构的疼痛医学中心,并接受多方面干预。疼痛中心提供者根据他们的临床检查和图像解释来确定小平面干预的部位。根据小平面干预是否包括SPECT/CT扫描的最大摄取水平来形成组。在使用类固醇和局部麻醉剂的小平面注射或仅使用局部麻醉剂的内侧支阻滞的24小时内,对干预的积极反应被定义为减轻疼痛的50%和80%阈值。这些是用于我们数据收集的方面干预措施。卡方统计量用于分析分类数据,学生t检验用于分析非分类数据。SPSS(IBM公司IBMSPSS版本24.0)用于所有分析。
结果:在我们的112名患者中,第1组由89人组成,干预发生在SPECT/CT摄取增加的水平。第2组包括23例患者,其干预水平在SPECT/CT上没有摄取。队列之间的人口统计学数据没有显着差异。独立性的卡方检验表明,与SPECT/CT一致的干预水平与自我报告的50%和80%的疼痛缓解阈值显着相关(p=.0002)。
结论:基于SPECT/CT扫描摄取的方面干预在减轻疼痛方面比没有的干预更成功。这表明SPECT/CT在诊断颈部疼痛的治疗目标中的作用。
方法:
BACKGROUND: Previous studies have reported that magnetic resonance imaging (MRI) and computed tomography (CT) do not predict response to facet blocks. However, single photon emission computed tomography (SPECT) uptake within facet joints has been shown to correlate with pain relief after intervention in the lumbar spine. There is minimal data regarding the predictive value of single photon emission computed tomography/computed tomography (SPECT/CT) for neck pain.
OBJECTIVE: The aim of this study was to evaluate the utility of SPECT/CT in patients with axial neck pain for the identification of specific facet joints that would benefit from diagnostic and therapeutic facet joint steroid injections and/or medial branch block/RFA treatments.
METHODS: A retrospective cohort study.
METHODS: One hundred seventy-nine patients at a single institution pain center with neck pain and a SPECT/CT scan between 2009 and 2015. One hundred twelve patients had no prior intervention at the level of interest and met inclusion criteria.
METHODS: Pain reduction at 50% and 80% thresholds within 24 hours of facet intervention. Concordance of facet intervention with the focus of maximal uptake on SPECT/CT scan.
METHODS: All patients were referred to our institution\'s Center for Pain Medicine and were treated with facet interventions. The site of facet intervention was determined by pain center providers based on their clinical examination and interpretation of images. Groups were formed based on whether the facet intervention included the level of maximal uptake on SPECT/CT scan. A positive response to intervention was defined at both 50% and 80% thresholds for reduction in pain within 24 hours of facet injection with steroid and local anesthetic or medial branch block with local anesthetic only. These were the facet interventions used for our data collection. A Chi-square statistic was used to analyze categorical data and a Student\'s t-test was used to analyze non-categorical data. SPSS (IBM Corp. IBM SPSS Version 24.0) was used for all analyses.
RESULTS: Of our 112 patients, Group 1 consisted of 89 with an intervention occurring at the level with increased uptake on SPECT/CT. Group 2 consisted of 23 patients with an intervention at a level without uptake on SPECT/CT. Demographic data did not significantly differ between cohorts. A Chi-square test of independence demonstrated that intervention at a level concordant with SPECT/CT was significantly correlated with self-reported pain relief thresholds of both 50% and 80% (p=.0002).
CONCLUSIONS: Facet interventions based on SPECT/CT scan uptake were more successful in pain reduction than those which were not. This suggests a role for SPECT/CT in diagnosing therapeutic targets for neck pain.
METHODS: