Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Konvansiyonel Radyofrekans ile Yapılan Lomber Mediyal Dal Nörotomisinin Lomber Faset Eklem Ağrısı Olan Hastalarda Kısa ve Uzun Dönemdeki Etkinliğinin Retrospektif Değerlendirilmesi
Retrospective Evaluation of the Short and Long Term Effectiveness of Conventional Radiofrequency Performed for Medial Branch Neurotomy in Patients with Lumbar Facet Joint Pain
Abdulkadir YEKTAŞa
aAnesteziyoloji ve Reanimsyon Kliniği, Sağlık Bilimleri Üniversitesi Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Diyarbakır, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2019;17(3):69-76
doi: 10.5336/anesthe.2019-70717
Article Language: TR
Full Text
ÖZET
 Amaç: Kortikosteroid ile intraartiküler enjeksiyon ya da mediyal dal bloğu, lomber faset eklemlerden köken alan kronik bel ağrısı yönetiminde geleneksel olarak yaygın kullanılır. Fakat bu prosedürlerin kanıt düzeyleri düşük ya da orta düzeydedir. Bir alternatif olarak lomber mediyal dalın radyofrekans nörolizisi lomber faset eklem ağrısının yönetiminde kullanılabilir. Biz bu çalışmada, kronik bel ağrısı olan lomber faset eklem sendromlu hastalarda mediyal dalın konvansiyonel radyofrekans ile nörotomisinin etkinliğini retrospektif incelemeyi amaçladık. Gereç ve Yöntemler: Konvansiyonel radyofrekans uygulanan hastaların (n=51) dosyaları tarandı. Tüm hastaların işlem öncesi ve işlem sonrası 1-3-6. ay ve 1-2. yıl vizüel analog skala (VAS) değerleri dosyalardan kaydedildi. Hastaların işlem öncesi ve işlem sonrası 1-3-6. ay ve 1-2. yıl VAS değerleri karşılaştırıldı. Hastaların ikinci yıl sonundaki Odom kriterleri kaydedildi. Bulgular: Hastaların işlem öncesi VAS değerleriyle işlem sonrası 1-3-6. ay ve 1-2. yıl VAS değerleri karşılaştırıldı ve işlem öncesi VAS değerleri istatistiksel olarak anlamlı yüksekti. İki yılın sonunda Odom kriterleri gösterdi ki hastalar tedaviden çok fayda görmüşlerdi. Sonuç: Lomber faset eklem ağrısı olan hastalarda mediyal dal nörotomisi için konvansiyonel radyofrekans, kısa ve uzun dönemde VAS değerlerini etkin olarak düşürmektedir.

Anahtar Kelimeler: Lomber faset eklem sendromu; Konvansiyonel radyofrekans; Vizüel analog skala değerleri
ABSTRACT
 Objective: Intraarticular injections with corticosteroid or medial branch block are traditionally used prevalently in the management of chronic back pain due to lumbar facet joints. However, the evidence levels of these procedures are either at a low or medium level. Radiofrequency neurolysis of the lumbar medial branch can be used as an alternative in the management of lumbar facet joint pain. In this study, our aim retrospective analysed efficiency of conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurotomy in both short and long term. Material and Methods: Patients' files (n=51) were screened whose administreted conventional radiofrequency. Pre-op and post-op 1st, 3rd, 6thmonth and 1st, 2nd year visual analog scale (VAS) values of all patients were asked, recorded, and statistically compared. VAS values of the groups in the same months were compared as well. At the end of the second year, Odom criteria of patients were recorded. Results: Pre-operation VAS values and post-operation 1st, 3rd, 6th month and 1st, 2nd year VAS values were compared in patients, and there was a statistically significant difference between pre-operation VAS values and post-operation 1st, 3rd, 6thmonth and 1st, 2nd year VAS values in patients. Odom criteria patients at the end of the second year, it was observed that the patients were more satisfied with the treatment. Conclusion:Conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurotomy statistically significant decreases VAS values in both short and long term.

Keywords: Lumbar facet joint syndrome; Conventional radiofrequency; Visuel analog scale score
REFERENCES:
  1. From the Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults--United States, 1999. JAMA. 2001;285(12):1571-2. [Crossref]  [PubMed] 
  2. Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J. 2007;16(10):1539-50. [Crossref]  [PubMed]  [PMC] 
  3. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial Spine (Phila Pa 1976). 2000;25(10):1270-7. [Crossref]  [PubMed] 
  4. Alberts WW, Wright EW Jr, Feinstein B, Von Bonin G. Experimental radiofrequency brain lesion size as a function of physical parameters. J Neurosurg. 1966;25(4):421-3. [Crossref]  [PubMed] 
  5. Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine (Phila Pa 1976). 1998;23(18):1972-6. [Crossref]  [PubMed] 
  6. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. 1994;58(2):195-200. [Crossref] 
  7. Hammer M, Meneese W. Principles and practice of radiofrequency neurolysis. Curr Rev Pain. 1998;2(4):267-78. [Crossref] 
  8. Sluijter ME, van Kleef M. Pulsed radiofrequency. Pain Med. 2007;8(4):388-9. [Crossref]  [PubMed] 
  9. Manchikanti L, Pampati V, Fellows B, Baha AG. The inability of the clinical picture to characterize pain from facet joints. Pain Physician. 2000;3(2):158-66.
  10. Manchikanti L, Pampati V, Fellows B, Bakhit CE. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999;2(3):59-64. PMID: 16906217
  11. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976). 1994;19(10):1132-7. [Crossref]  [PubMed] 
  12. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591-614. [Crossref]  [PubMed] 
  13. Taylor JR, Twomey LT. Age changes in lumbar zygapophyseal joints. Observations on structure and function. Spine (Phila Pa 1976). 1986;11(7):739-45. [Crossref]  [PubMed] 
  14. van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N. 12. Pain originating from the lumbar facet joints. Pain Pract. 2010;10(5):459-69. [Crossref]  [PubMed] 
  15. Amrhein TJ, Joshi AB, Kranz PG. Technique for CT fluoroscopy-guided lumbar medial branch blocks and radiofrequency ablation. AJR Am J Roentgenol. 2016;207(3):631-4. [Crossref]  [PubMed] 
  16. Lakemeier S, Lind M, Schultz W, Fuchs-Winkelmann S, Timmesfeld N, Foelsch C, et al. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg. 2013;117(1):228-35. [Crossref]  [PubMed] 
  17. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007;10(3):425-40.
  18. Manchikanti L, Singh V, Vilims BD, Hansen HC, Schultz DM, Kloth DS. Medial branch neurotomy in management of chronic spinal pain: systematic review of the evidence. Pain Physician. 2002;5(4):405-18.
  19. Ribeiro LH, Furtado RN, Konai MS, Andreo AB, Rosenfeld A, Natour J. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2013;38(23):1995-2002. [Crossref]  [PubMed] 
  20. Shih C, Lin GY, Yueh KC, Lin JJ. Lumbar zygapophyseal joint injections in patients with chronic lower back pain. J Chin Med Assoc. 2005;68(2):59-64. [Crossref] 
  21. Boswell MV, Colson JD, Spillane WF. Therapeutic facet joint interventions in chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005;8(1):101-14.
  22. Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician. 2002;5:182-99.
  23. Manchikanti L, Boswell MV, Singh V, Benyamin RM, Fellows B, Abdi S, et al; ASIPP-IPM. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12(4):699-802.
  24. Leon JF, Ortiz JG, Fonseca EO, Martinez CR, Cuellar GO. Radiofrequency neurolysis for lumbar pain using a variation of the original technique. Pain Physician. 2016;19(3):155-61.
  25. Nedelka T, Nedelka J, Schlenker J, Hankins C, Mazanec R. Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy. Neuro Endocrinol Lett. 2014;35(5):393-7.
  26. Aydin SM, Gharibo CG, Mehnert M, Stitik TP. The role of radiofrequency ablation for sacroiliac joint pain: a meta-analysis. PM R. 2010;2(9):842-51. [Crossref]  [PubMed] 
  27. Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain. 1997;13(4):285-302. [Crossref] 
  28. Sluijter ME, Cosman ER, Rittmann WB. The effects of pulsed radiofrequency fields applied to the dorsal root ganglion: a preliminary report. Pain Clin. 1998;11(2):109-17.
  29. Broekema AEH, Molenberg R, Kuijlen JMA, Groen RJM, Reneman ME, Soer R. The Odom criteria: validated at last: a clinimetric evaluation in servical spine surgery. J Bone Joint Surg Am. 2019;101(14):1301-6. [Crossref]  [PubMed] 
  30. van Suijlekom HA, van Kleef M, Barendse GA, Sluijter ME, Sjaastad O, Weber WE. Radiofrequency cervical zygapophyseal joint neurotomy for cervicogenic headache: a prospective study of 15 patients. Funct Neurol. 1998;13(4):297-303.
  31. Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976). 2003;28(20):2419-25. [Crossref]  [PubMed] 
  32. Teixeira A, Sluijter ME. Intradiscal high-voltage, long-duration pulsed radiofrequency for discogenic pain: a preliminary report. Pain Med. 2006;7(5):424-8. [Crossref]  [PubMed] 
  33. Smith HP, McWhorter JM, Challa VR. Radiofrequency neurolysis in a clinical model. Neuropathological correlation. J Neurosurg. 1981;55(2):246-53. [Crossref]  [PubMed] 
  34. Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008;24(8):717-24. [Crossref]  [PubMed] 
  35. Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine (Phila Pa 1976). 2001;26(13):1411-6. [Crossref]  [PubMed] 
  36. Bogduk N, Long DM. The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain. J Neurosurg. 1979;51(2):172-7. [Crossref]  [PubMed] 
  37. Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770-80. [Crossref]  [PubMed] 

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