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71.
Background Context
Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.Purpose
We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol.Study Design/Setting
A meta-analysis of randomized controlled trials was carried out.Patient Sample
Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample.Outcome Measures
Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures.Method
We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models.Results
We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments.Conclusions
Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. 相似文献72.
目的探讨舌咽神经痛的发病机制、不同临床术式选择及疗效、并发症之间的关系。方法对22例舌咽神经痛的病人,采用枕下乙状窦后入路,进行手术探查,选择性对14例病人进行微血管减压,8例进行舌咽神经根、迷走神经根上部1～2根丝切断术。结果 3例微血管减压术术后的病人出现短暂性声音嘶哑、饮水呛咳,6个月内好转消失;1例一直有咽喉部不适;8例神经根切断的病人术后均有声音嘶哑、饮水呛咳症状,4例6个月后症状减轻。术毕疼痛均消失,平均随访5年以上无复发。结论根据责任血管能否移开,神经根能否充分游离减压情况,选择性进行微血管减压以及舌咽神经根、迷走神经根丝切断术是治疗舌咽神经痛安全、有效的治疗方法。 相似文献