Interventional Pain Medicine最新文献_第5页

Comprehensive genicular nerve radiofrequency ablation for refractory knee pain using a dual-tined electrode: A technical description and cross-sectional cohort study 双电极膝神经射频消融治疗难治性膝关节疼痛：技术描述和横断面队列研究

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-19 DOI: 10.1016/j.inpm.2025.100656

Hasan Sen, Audrey Adler, Amanda N. Cooper, Napatpaphan Kanjanapanang, Jason E. Mascoe, Alexandra E. Fogarty, Allison Glinka Przybysz, Aaron Conger, Zachary L. McCormick

Background

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.

Objectives

Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.

Methods

Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a “much improved” or better status.

Results

Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0–72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6–81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2–76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.

Conclusion

Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.

膝神经射频消融术（GNRFA）是治疗顽固性膝关节疼痛的有效方法。然而，随着新技术的出现以及越来越多的证据支持扩大病变策略，GNRFA协议的改进正在进行中。目的：描述一种新的、全面的GNRFA方案，利用双针电极靶向6个膝神经，并在横断面队列中报告临床结果。该技术结合了双极和单极消融，以实现精确、有效的损伤。方法对在某三级学术中心连续接受GNRFA治疗的患者进行随访。从电子病历中收集基线人口统计和临床数据，并通过标准化电话调查评估结果。主要结局是数值评定量表（NRS）疼痛评分降低≥50%的参与者比例。次要结局包括NRS降低≥2分和患者整体印象改变（PGIC）评分≥6分的受试者比例，反映了“大大改善”或更好的状态。结果纳入14例患者（16例GNRFA手术）。在平均随访9.0±1.5个月时，50.0% （95% CI:28.0 - 72.0%）的参与者报告NRS降低≥50%，62.5% （95% CI:38.6 - 81.5%）的参与者报告NRS降低≥2点，56.3% （95% CI:33.2 - 76.9%）的参与者报告PGIC评分≥6。随访期间没有新的阿片类药物使用、关节置换术或手术并发症的报道。结论：我们的扩展的6神经GNRFA方案使用双针电极，在大多数患者中提供了临床显着的疼痛缓解，无相关并发症。该技术有望作为一种安全、有效的治疗方案，用于选择单膝神经阻滞需要≥50%疼痛缓解的膝关节骨关节炎患者的难治性膝关节疼痛。需要更大规模的前瞻性研究和更长时间的随访来证实这些发现。

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引用次数: 0

Patient-reported outcomes following radiofrequency ablation of the hip: a retrospective study 髋关节射频消融后患者报告的结果：一项回顾性研究

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-10-01 DOI: 10.1016/j.inpm.2025.100645

Melissa Schwartz , Alejandra Cardenas-Rojas , Michael Suarez , Anna Megenhardt , Ahmed Khawer , Annie Yang , Eric Muneio , Pranamya Suri , Akhil Chhatre

Background

Chronic hip pain, primarily caused by osteoarthritis, is a prevalent condition that significantly reduces quality of life for many individuals. Radiofrequency ablation (RFA) has emerged as a promising, minimally invasive treatment targeting sensory nerves around the hip joint to provide sustained relief. However, guidelines for selecting suitable patients and predicting outcomes remain unclear.

Objective

This study aimed to evaluate patient-reported pain outcomes following hip RFA and to identify pre-procedure patient factors influencing treatment response.

Methods

In this retrospective study conducted at a tertiary academic center, data was collected from patients undergoing unilateral or bilateral RFA of the articular branches of the obturator and femoral nerves between August 2019 and August 2024. Information collected included demographics, osteoarthritis severity, opioid and antidepressant use, and pre- and post-procedure numeric rating scale (NRS) scores for pain. Primary outcome measures were pre-post difference NRS score, considering clinically meaningful a ≥2-point improvement in NRS and ≥50 % pain reduction. Secondary outcomes included patient perceptions measured using the Patient Global Impression of Change (PGIC) scale. Logistic regression analysis was conducted to identify predictors of treatment success.

Results

Fifty-four patients (64 procedures) participated, predominantly female (64.8 %), with an average age of 68 years old and BMI of 31.43 kg/m². A significant median reduction of 2.5 points in NRS was reported post-procedure (p < 0.001). Overall, 56.25 % of patients achieved a clinically meaningful ≥2-point NRS reduction, and 43.75 % experienced ≥50 % pain reduction. Approximately 66 % of patients reported improvement on the PGIC scale. The average duration of pain relief among responders was six months. Patients without pre-procedure opioid use (OR = 0.24, p = 0.027) and those with higher BMI (p = 0.04) had significantly better outcomes.

Conclusion

Hip RFA demonstrates potential in reducing pain levels and improving patient-reported outcomes in individuals with chronic hip pain. Better outcomes were notably associated with the absence of pre-procedure opioid use and higher BMI. Further research is needed to refine patient selection guidelines and to evaluate functional improvements following the procedure.

主要由骨关节炎引起的慢性髋关节疼痛是一种普遍的疾病，对许多人来说，它会显著降低生活质量。射频消融术（RFA）是一种很有前途的微创治疗方法，针对髋关节周围的感觉神经提供持续的缓解。然而，选择合适的患者和预测结果的指南仍然不清楚。目的本研究旨在评估髋关节射频消融术后患者报告的疼痛结果，并确定影响治疗反应的术前患者因素。方法本回顾性研究于2019年8月至2024年8月在某三级学术中心进行，收集了2019年8月至2024年8月期间接受闭孔神经和股神经关节分支单侧或双侧RFA的患者的数据。收集的信息包括人口统计、骨关节炎严重程度、阿片类药物和抗抑郁药物的使用，以及手术前后疼痛的数字评定量表（NRS）评分。主要结局指标为NRS评分前后差异，考虑NRS改善≥2分和疼痛减轻≥50%的临床意义。次要结果包括使用患者整体变化印象（PGIC）量表测量的患者感知。进行Logistic回归分析以确定治疗成功的预测因素。结果共54例患者（64例手术），女性居多（64.8%），平均年龄68岁，BMI 31.43 kg/m2。术后NRS中位数显著降低2.5个点（p < 0.001）。总体而言，56.25%的患者达到临床意义≥2点的NRS降低，43.75%的患者疼痛减轻≥50%。大约66%的患者报告PGIC评分有所改善。应答者疼痛缓解的平均持续时间为6个月。术前未使用阿片类药物的患者（OR = 0.24, p = 0.027）和BMI较高的患者（p = 0.04）的预后明显较好。结论髋关节RFA在减轻慢性髋关节疼痛患者疼痛水平和改善患者报告的预后方面具有潜力。较好的结果明显与术前阿片类药物的使用和较高的BMI有关。需要进一步的研究来完善患者选择指南并评估手术后的功能改善。

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引用次数: 0

A case report: Infrazygomatic approach neurocryoablation of the sphenopalatine ganglion under cone beam computer tomography guidance in treating refractory headaches 锥束计算机断层引导下颧下入路蝶腭神经节冷冻消融治疗顽固性头痛1例

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-25 DOI: 10.1016/j.inpm.2025.100706

Logan F. Condon , Ryu Komatsu , Jiang Wu

Introduction

The sphenopalatine ganglion (SPG) drives the cranial autonomic symptoms associated with trigeminal autonomic cephalalgias, migraine, and trigeminal neuralgia. Infrazygomatic approach SPG block serves as the gold standard for both prognostic and therapeutic intervention for management of refractory headache with autonomic symptoms. However, this intervention often provides only short-term relief. Identification of novel interventions that provide more durable relief is imperative.

Case

An 84-year-old female with chronic headache featuring autonomic cranial symptoms that failed both medication and conservative intervention management. Patient responded well to infrazygomatic approach SPG block using combined cone beam CT and fluoroscopy guidance, however, experienced fading therapeutic response over the years. Subsequently, patient underwent neurocryoablation of the SPG, from which, satisfactory and sustained improvement of her headache pain was achieved at six month follow up.

Conclusion

This is the first case demonstrating the clinical feasibility and therapeutic outcomes of SPG neurocryoablation in treating refractory headaches.

蝶腭神经节（SPG）驱动与三叉神经痛、偏头痛和三叉神经痛相关的颅自主神经症状。颧骨下入路SPG阻滞是治疗伴有自主神经症状的难治性头痛的预后和治疗干预的金标准。然而，这种干预往往只能提供短期的缓解。确定新的干预措施，提供更持久的缓解是必要的。一例84岁女性慢性头痛，伴有自主神经症状，药物治疗和保守干预治疗均失败。在锥形束CT和透视引导下，患者对颧下入路SPG阻滞反应良好，但随着时间的推移，治疗反应逐渐消退。随后，患者接受了SPG神经冷冻消融，在6个月的随访中，患者的头痛得到了满意和持续的改善。结论首次证实了SPG神经冷冻消融治疗顽固性头痛的临床可行性和疗效。

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引用次数: 0

Subject: Letters to the editor: Re: rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database 主题：致编辑的信：Re：椎体神经消融后腰椎压缩性骨折的发生率：一项利用大型国家数据库的回顾性研究

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-29 DOI: 10.1016/j.inpm.2025.100712

Patricia Zheng, Conor O'Neill

引用次数: 0

Intrathecal drug delivery for chronic abdominal pain: A case series 鞘内给药治疗慢性腹痛：一个病例系列

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-12-02 DOI: 10.1016/j.inpm.2025.100703

Harold Burke , Michael Liu , Salim M. Hayek

Introduction

Chronic Abdominal Pain (CAP) is a pervasive and challenging global health issue. In a 2023 United States National Health Interview Survey, CAP was present in almost 3 % of all respondents. Various interventional procedures, such as sympathetic nerve blocks (SNBs), thoracolumbar sympathetic ablations, and spinal cord stimulation (SCS), have shown mixed efficacy in managing CAP. This case series describes refractory CAP that is effectively managed with IDD after a treatment algorithm to first distinguish nociceptive pain from a centrally mediated process, but only when the AGA ROME IV criteria for CAP is met.

Methods

Four patients were identified in clinical practice as suitable candidates for an IDD for refractory, non-centrally mediated CAP. Two of the patients had constant CAP meeting the ROME IV AGA diagnostic criteria for CAP and therefore underwent a DDE-ultimately with findings suggestive of visceral or somatic pain given a >70 % reduction in pain after administration of the local anesthetic and confirmation of a sensory level change, but not after the administration of normal saline prior. (Tabe 1). All patients underwent a continuous intrathecal catheter trial, except for one patient with cystic fibrosis and unpredictable pancreatitis pain episodes, who had failed a spinal cord stimulator implant and proceeded straight to an IDDS implant.

Results

IDD effectively managed refractory CAP across these four cases, with implantation durations ranging from 1.5 to 10 years. All patients remained off systemic opioids and maintained complete functional independence-specifically their Activities of Daily Living (ADLs) as well as Instrumental ADLs.

Discussion

Effective management of CAP begins with a precise diagnosis that distinguishes between nociceptive and centrally mediated pain. Once centrally mediated pain is excluded, and provided patients did not experience sufficient analgesia with other less invasive interventions, targeted treatment for visceral/nociceptive pain with intrathecal drug delivery can be attempted. This case series highlights IDD as a promising alternative to other interventional therapies for refractory CAP, offering durable pain relief with potentially fewer complications.

慢性腹痛（CAP）是一个普遍和具有挑战性的全球健康问题。在2023年美国全国健康访谈调查中，几乎3%的受访者存在CAP。各种介入治疗方法，如交感神经阻滞（SNBs）、胸腰段交感神经消融和脊髓刺激（SCS），在治疗CAP方面显示出不同的疗效。本病例系列描述了在治疗算法首先区分伤害性疼痛和中枢介导过程后，用IDD有效治疗难治性CAP的难治性CAP，但只有在满足AGA ROME IV CAP标准的情况下。方法：在临床实践中，4例患者被确定为难治性非中枢介导性CAP的合适IDD候选人。其中2例患者的持续性CAP符合ROME IV AGA对CAP的诊断标准，因此接受了dde，最终发现提示内脏或躯体疼痛，在给予局麻药并确认感觉水平改变后疼痛减轻了70%，但在给予生理盐水后没有。(课程1)。所有患者都进行了连续的鞘内导管试验，除了一名患有囊性纤维化和不可预测的胰腺炎疼痛发作的患者，他在脊髓刺激器植入失败后直接进行了IDDS植入。结果4例患者中，sidd有效控制了难治性CAP，植入时间从1.5年到10年不等。所有患者都没有使用全身性阿片类药物，并保持了完全的功能独立性，特别是他们的日常生活活动（adl）和工具性adl。CAP的有效管理始于对伤害性疼痛和中枢介导性疼痛的精确诊断。一旦排除了中枢介导的疼痛，并且患者在其他侵入性较小的干预措施下没有获得足够的镇痛，可以尝试鞘内给药靶向治疗内脏/伤害性疼痛。本病例系列强调IDD作为难治性CAP的其他介入治疗的有希望的替代方法，提供持久的疼痛缓解，潜在的并发症更少。

{"title":"Intrathecal drug delivery for chronic abdominal pain: A case series","authors":"Harold Burke , Michael Liu , Salim M. Hayek","doi":"10.1016/j.inpm.2025.100703","DOIUrl":"10.1016/j.inpm.2025.100703","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic Abdominal Pain (CAP) is a pervasive and challenging global health issue. In a 2023 United States National Health Interview Survey, CAP was present in almost 3 % of all respondents. Various interventional procedures, such as sympathetic nerve blocks (SNBs), thoracolumbar sympathetic ablations, and spinal cord stimulation (SCS), have shown mixed efficacy in managing CAP. This case series describes refractory CAP that is effectively managed with IDD after a treatment algorithm to first distinguish nociceptive pain from a centrally mediated process, but only when the AGA ROME IV criteria for CAP is met.</div></div><div><h3>Methods</h3><div>Four patients were identified in clinical practice as suitable candidates for an IDD for refractory, non-centrally mediated CAP. Two of the patients had constant CAP meeting the ROME IV AGA diagnostic criteria for CAP and therefore underwent a DDE-ultimately with findings suggestive of visceral or somatic pain given a >70 % reduction in pain after administration of the local anesthetic and confirmation of a sensory level change, but not after the administration of normal saline prior. (Tabe 1). All patients underwent a continuous intrathecal catheter trial, except for one patient with cystic fibrosis and unpredictable pancreatitis pain episodes, who had failed a spinal cord stimulator implant and proceeded straight to an IDDS implant.</div></div><div><h3>Results</h3><div>IDD effectively managed refractory CAP across these four cases, with implantation durations ranging from 1.5 to 10 years. All patients remained off systemic opioids and maintained complete functional independence-specifically their Activities of Daily Living (ADLs) as well as Instrumental ADLs.</div></div><div><h3>Discussion</h3><div>Effective management of CAP begins with a precise diagnosis that distinguishes between nociceptive and centrally mediated pain. Once centrally mediated pain is excluded, and provided patients did not experience sufficient analgesia with other less invasive interventions, targeted treatment for visceral/nociceptive pain with intrathecal drug delivery can be attempted. This case series highlights IDD as a promising alternative to other interventional therapies for refractory CAP, offering durable pain relief with potentially fewer complications.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100703"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database 腰椎神经消融后腰椎压缩性骨折的发生率：一项利用大型国家数据库的回顾性研究

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-19 DOI: 10.1016/j.inpm.2025.100654

Justin Chau , Durga Ghosh , Sean Fox , Ayahiro D. Takashima , Andrew Stephens

Background

Basivertebral nerve ablation (BVNA) is an effective treatment for vertebrogenic chronic low back pain. However, data regarding rates of post-BVNA lumbar vertebral compression fracture (VCF), particularly among patients with osteoporosis or osteopenia, remains limited.

Objective

(1) Estimate the rate of lumbar VCF after BVNA. (2) Compare rates between patients with and without a pre-BVNA diagnosis of osteopenia/osteoporosis utilizing a large global database.

Methods

A retrospective cohort study was performed using TriNetX, a national database of de-identified health records from over 130 million patients. Adults (≥18 years) who underwent BVNA between January 2022 and August 2025 were identified via CPT code. Patients were stratified by presence or absence of ICD-10 code for osteoporosis/osteopenia before undergoing BVNA. The primary outcome was incidence of ICD-10 code diagnosis of lumbar VCF after undergoing BVNA.

Results

A total of 2387 patients underwent BVNA (mean age 63.7 years; 48.0 % female). Of these, 669 had a pre-BVNA diagnosis of osteoporosis/osteopenia (mean age 70.2 ± 10.7 years; 64.4 % female). Lumbar VCF occurred in 37 patients (1.55 %; 95 % CI, 1.11–2.16 %) after BVNA. Patients with osteoporosis/osteopenia had higher rate of post-BVNA lumbar VCF compared to those without (4.64 % vs 0.37 %), though rates of post-BVNA lumbar VCF were overall low across all patients (1.55 %). Osteoporosis/osteopenia was independently associated with post-BVNA VCF (adjusted OR 6.5; 95 % CI, 3.7–12.3; p < 0.001).

Conclusion

While patients with pre-BVNA ICD-10 code diagnosis of osteoporosis/osteopenia had higher rates and were at higher risk of post-BVNA VCF than those without, overall rates were still low. Risk of VCF should be considered and risks/benefits should be discussed with patients, but a diagnosis of osteoporosis/osteopenia should not be considered an absolute contraindication to BVNA.

背景：椎体神经消融术（BVNA）是治疗椎源性慢性腰痛的有效方法。然而，关于bvna后腰椎压缩性骨折（VCF）发生率的数据，特别是骨质疏松或骨质减少患者的数据仍然有限。目的(1)评估BVNA术后腰椎VCF发生率。(2)利用一个大型的全球数据库，比较有和没有bvna前诊断骨质减少/骨质疏松症的患者之间的比率。方法使用TriNetX进行回顾性队列研究，TriNetX是一个包含超过1.3亿患者的未识别健康记录的国家数据库。在2022年1月至2025年8月期间接受BVNA的成人（≥18岁）通过CPT代码进行识别。在接受BVNA之前，根据是否存在骨质疏松症/骨质减少症的ICD-10代码对患者进行分层。主要观察指标为行BVNA后腰椎VCF的ICD-10码诊断发生率。结果共2387例患者行BVNA，平均年龄63.7岁，女性48.0%。其中，669例bvna前诊断为骨质疏松/骨质减少（平均年龄70.2±10.7岁，64.4%为女性）。37例患者在BVNA后发生腰椎VCF （1.55%; 95% CI, 1.11 - 2.16%）。骨质疏松/骨质减少患者的bvna后腰椎VCF发生率高于无bvna患者（4.64% vs 0.37%），尽管所有患者的bvna后腰椎VCF发生率总体较低（1.55%）。骨质疏松/骨质减少与bvna后VCF独立相关（校正OR 6.5; 95% CI, 3.7-12.3; p < 0.001）。结论虽然bvna前ICD-10编码诊断为骨质疏松/骨质减少的患者比未诊断为bvna后发生VCF的患者有更高的发生率和风险，但总体发生率仍较低。应考虑VCF的风险，并与患者讨论风险/益处，但不应将骨质疏松/骨质减少的诊断视为BVNA的绝对禁忌症。

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引用次数: 0

FACTFINDERS for PATIENT SAFETY: Minimizing complications in radiofrequency neurotomy: Part I—Implantable devices; Part II—Preprocedural BVNRFN imaging 患者安全的factfinder：减少射频神经切开术并发症：第一部分-植入式装置第二部分：术前BVNRFN成像

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-22 DOI: 10.1016/j.inpm.2025.100650

David Hao , Gerald Yeung , Haewon Lee , Zheyan Chen , Ben Laplante , Paul Kitei , Reza Ehsanian , David Levi

This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding minimizing risks with radiofrequency neurotomy procedures.

The evidence in support of the following facts is presented: (1) While data on the safety of radiofrequency neurotomy in patients with implanted devices are limited, the procedure can likely be performed safely with careful adherence to best practices and manufacturer recommendations. (2) Basivertebral nerve radiofrequency neurotomy can be performed safely and effectively at the L3 through S1 vertebral levels. Scrutiny of preprocedural imaging may minimize risk. Although the transpedicular approach is preferred, patient anatomy may dictate a non-transpedicular trajectory.

本系列的factfinder对证据进行了简要总结，并概述了如何将射频神经切开术的风险降到最低的建议。支持以下事实的证据被提出：(1)虽然射频神经切开术在植入设备患者中的安全性数据有限，但如果仔细遵守最佳实践和制造商建议，该手术可能会安全进行。(2)基底神经射频神经切开术可以在L3至S1椎体水平安全有效地进行。仔细检查手术前的影像可以将风险降到最低。虽然经椎弓根入路是首选，但患者的解剖结构可能决定非经椎弓根轨迹。

引用次数: 0

Letter to the Editor: Intellectual conflicts of interest in spinal cord stimulation research - The gap between theoretical knowledge and clinical expertise 致编辑的信：脊髓刺激研究中的知识冲突-理论知识与临床专业知识之间的差距

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-30 DOI: 10.1016/j.inpm.2025.100715

Hemant Kalia , Scott Pritzlaff , Konstantin Slavin

引用次数: 0

The effectiveness of thoracic medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study 使用三针电极射频消融胸内侧分支的有效性：一项真实世界的横断面队列研究

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-10-31 DOI: 10.1016/j.inpm.2025.100649

Hasan Sen , Edvin Koshi , Matthew Essman , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick

Background

Thoracic medial branch radiofrequency ablation (TMBRFA) is used to treat chronic thoracic spine pain, but data regarding its effectiveness and technique remain limited.

Objectives

Evaluate outcomes of TMBRFA using a three-tined electrode in patients with thoracic facet joint pain.

Methods

Consecutive patients who underwent first-time TMBRFA at a single tertiary academic center between 2022 and 2024 were identified and contacted for follow-up via standardized telephone survey at ≥6 months post-procedure. Baseline demographic and clinical data were extracted from electronic medical records. Outcomes included the proportions of patients with ≥50% numerical rating scale (NRS) pain score reduction, ≥2-point NRS reduction, and Patient Global Impression of Change (PGIC) scores ≥6 (indicating at least “much improved”). Mean NRS pain score reduction and changes in opioid use from baseline were also assessed.

Results

Outcomes were successfully collected from 11 patients. At a mean follow-up of 20.6 ± 7.6 months, 36.4% (95%CI: 15.2–64.6) and 45.5% (95%CI: 21.3–72.0) of patients reported ≥50% and ≥2-point NRS reductions, respectively, with 54.6% (95%CI: 28.0–78.7) reporting PGIC scores ≥6. Mean NRS pain score reduction was 1.9 ± 2.7 points. Two patients had ceased using opioids at follow-up, representing a proportional decrease of 18.2% compared to baseline.

Conclusion

In this cohort, approximately half of patients who underwent first-time TMBRFA with a three-tined electrode experienced clinically meaningful pain relief and perceived overall improvement at an average follow-up of nearly 2 years. Larger, prospective studies are needed to corroborate these findings.

背景胸椎内侧支射频消融术（TMBRFA）用于治疗慢性胸椎疼痛，但有关其有效性和技术的数据仍然有限。目的评价三针电极TMBRFA治疗胸椎小关节疼痛的疗效。方法确定2022 - 2024年间在单一三级学术中心接受首次TMBRFA治疗的连续患者，并在术后≥6个月通过标准化电话调查进行随访。从电子病历中提取基线人口统计学和临床数据。结果包括数值评定量表（NRS）疼痛评分降低≥50%，NRS评分降低≥2分，患者整体印象变化（PGIC）评分≥6（至少表明“明显改善”）的患者比例。平均NRS疼痛评分减少和阿片类药物使用的变化也从基线进行了评估。结果成功收集了11例患者的结果。在平均随访20.6±7.6个月时，分别有36.4% （95%CI: 15.2-64.6）和45.5% （95%CI: 21.3-72.0）的患者报告NRS降低≥50%和≥2点，其中54.6% （95%CI: 28.0-78.7）的患者报告PGIC评分≥6。NRS疼痛评分平均降低1.9±2.7分。两名患者在随访中停止使用阿片类药物，与基线相比比例下降18.2%。在这个队列中，大约有一半的患者在平均随访近2年的时间里，首次接受TMBRFA和三针电极的患者经历了有临床意义的疼痛缓解和总体改善。需要更大规模的前瞻性研究来证实这些发现。

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引用次数: 0

Intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet MRI STIR signal. A prospective, multi-center case series 关节内颈椎小关节关节皮质类固醇注射患者小关节周围MRI STIR信号增高。前瞻性，多中心病例系列

Interventional Pain Medicine

Pub Date : 2025-12-01 Epub Date: 2025-10-09 DOI: 10.1016/j.inpm.2025.100646

Joshua Levin , Kevin Barrette , Cyrus Ghaffari , Reza Ehsanian , Jayme Koltsov , Christina Giacomazzi , Nitin Prabhakar , Lisa Huynh , Matthew Smuck , William Summers , Byron Schneider

Background

Intra-articular cervical facet joint corticosteroid injections are commonly performed, yet studies demonstrating benefit are limited.

Purpose

To evaluate success rates of intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet edema as demonstrated by MRI with STIR sequences.

Study design

Preliminary, prospective, multi-center case series.

Patient sample

Thirty-three patients from three independent spine centers.

Methods

Consecutive patients were enrolled with axial neck pain and peri-facet joint edema on MRI with STIR sequences when undergoing intra-articular cervical facet joint corticosteroid injections. Outcomes were prospectively collected at 2-4-weeks and at 3-months post-injection. The primary outcome was the proportion of patients with at least 50 % improvement in the numeric rating scale (NRS) pain score. Neck disability index (NDI) and global perception of change (GPC) were evaluated as secondary outcomes.

Results

At 2-4-weeks post-injection, 64 % [95 %CI: 46–79 %] of the 28 patients with follow-up data met criteria for success (≥50 % improvement in NRS). 86 % [95 %CI: 69–94 %] reported that they were better or much better on the GPC, and mean NDI improved from 19.3 to 8.9. At 3-months post-injection, 35 % [95 %CI: 19–54 %] of the 26 patients with follow-up data met criteria for success, and 50 % [95 %CI: 32–68 %] reported that they were better or much better on the GPC. Mean NDI at 3-months was 11.0.

Conclusions

Intra-articular cervical facet joint corticosteroid injections may provide short-term relief of neck pain in patients with peri-facet edema as demonstrated by MRI with STIR sequences. Intermediate-term results are less encouraging.

背景：经关节颈小面关节皮质类固醇注射是常用的治疗方法，但证明其益处的研究有限。目的通过MRI STIR序列分析，评价关节内注射皮质类固醇治疗关节突周围水肿患者的成功率。研究设计：初步、前瞻性、多中心病例系列。患者样本来自三个独立脊柱中心的33例患者。方法采用MRI STIR序列对颈椎小关节关节内注射皮质类固醇后出现轴性颈痛和小关节周围水肿的患者进行连续研究。在注射后2-4周和3个月前瞻性收集结果。主要结局是数字评定量表（NRS）疼痛评分改善至少50%的患者比例。颈部残疾指数（NDI）和整体感知变化（GPC）作为次要结局进行评估。结果注射后2-4周，随访数据的28例患者中有64% [95% CI: 46 ~ 79%]符合成功标准（NRS改善≥50%）。86% [95% CI: 69 - 94%]的患者报告GPC较好或较好，平均NDI从19.3提高到8.9。注射后3个月，26例随访数据患者中有35% [95% CI: 19 - 54%]符合成功标准，50% [95% CI: 32 - 68%]报告他们的GPC更好或更好。3个月时平均NDI为11.0。结论MRI STIR序列显示，关节内注射皮质类固醇可短期缓解关节面周围水肿患者的颈部疼痛。中期结果就不那么令人鼓舞了。

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