成人脊柱畸形患者选择性脊柱椎节基底椎体神经消融术。

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-08-24 DOI:10.14444/8632
Guy Fogel, Jake Dickinson, Sunny Vuong
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引用次数: 0

摘要

背景:消融支配椎体终板的椎基底神经(BVNA)已成为治疗椎体终板损伤引起的椎源性慢性腰背痛(CLBP)的标准疗法。在临床试验中,BVNA 对 CLBP 的治疗是成功和持久的,可以缓解疼痛并恢复日常活动。本病例回顾为临床试验中未提及的患有成人退行性脊柱畸形(ASD)和相关合并症的老年患者增添了新的信息:方法:118 名患有椎体源性 CLBP 的 ASD 患者在社区诊所接受了 503 个级别的 BVNA(平均 4.3 个级别)。41名合并症较少的患者(A组)与77名合并症较多的患者(B组)进行了比较。在进行 BVNA 前和最后一次随访(LFU)时,分别测量了视觉模拟量表(VAS 10 厘米)和 Oswestry 失能指数(ODI 100 分制):结果:A 组在 LFU 时的 VAS 平均为 2 厘米,改善了 7 厘米。B 组在 LFU 时的 VAS 为 3 厘米,改善了 6 厘米。在 LFU 时,A 组的 ODI 平均值为 14 点或轻度残疾,改善了 39 点;B 组改善了 28 点,达到 29 点,但仍为中度残疾。在 LFU,腰椎椎板切除术和 BVNA 治疗的 26 例腰椎管狭窄亚组的 VAS 平均值为 2 厘米,ODI 改善了 28 分,但平均仍为 21 分,最终为低度中度残疾。11例椎板切除术和BVNA患者的后柱疼痛仍与根性神经病、或周围神经病变有关,30%的患者有骶髂关节疼痛。B 组的 21 名活动性脊椎滑脱患者在接受 LFU 治疗后,VAS 改善了 6 厘米,ODI 改善了 25 分,但 ODI 仍为中度残疾。B 组患者在接受腰椎间盘置换术后,继续出现狭窄和根性病变症状的发生率为 20%。LFU 建议对 9 名患者进行腰椎融合术。这些患者年龄较大(平均 78 岁),均有严重的骨质疏松症。其中 8 例骨折发生在 BVNA 区域内,1 例为 S2 骶骨骨折。这些 VCF 患者接受了椎体成形术或椎体后凸成形术治疗,并在添加特立帕肽后继续接受预防性护理。在LFU时,VCF亚组的VAS略有改善,从6厘米降至4厘米,但仍有严重至中度残疾(Oswestry残疾指数平均为38分):结论:BVNA治疗CLBP的临床试验发现,该疗法在缓解疼痛和日常活动方面具有成功性和持久性。无合并症的 ASD 患者的椎体源性 CLBP 疼痛得到了持久缓解,并恢复了日常活动,这与临床试验结果相似。对于有合并症的患者,疼痛和残疾的改善可能会因合并症相关并发症而减弱。这是为患有脊柱畸形和其他合并症的老年患者提供的有关 BVNA 的新信息。这项研究可能会对研究实践和政策产生影响,从而将 BVNA 的适应症扩大到成年脊柱畸形患者:临床相关性:本系列病例是关于成人脊柱畸形患者接受 BVNA 治疗的唯一文献。结果是可预测和可重复的。许多患者感到满意,愿意再次接受治疗,并向亲朋好友推荐 BVNA。这一发现应能鼓励ASD患者接受BVNA治疗,事实上,BVNA可能应在任何融合术前进行,以限制和选择融合术的水平:4:
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Elective Spinal Transpedicular Ablation of the Basivertebral Nerve of the Vertebral Segment in Adult Spinal Deformity Patients.

Background: Ablation of the basivertebral nerve (BVNA) innervating the vertebral endplate has become a standard treatment of vertebrogenic chronic low back pain (CLBP) arising from vertebral endplate damage. BVNA treatment of CLBP in clinical trials was successful and durable for pain relief and return to daily activities. This case review adds new information about older patients with adult degenerative spinal deformity (ASD) and associated comorbidities not previously described in clinical trials.

Methods: One hundred and eighteen ASD patients with vertebrogenic CLBP in a community practice setting underwent 503 levels of BVNA (average 4.3 levels). Forty-one patients with minimal comorbidities (Group A) were compared to 77 patients with significant comorbidities (Group B). Visual analog scale (VAS 10 cm) and Oswestry Disability Index (ODI 100-point scale) were obtained before BVNA and at a last follow-up (LFU).

Results: Group A VAS at LFU was an average of 2 cm, a 7 cm improvement. Group B VAS at LFU was 3 cm, a 6 cm improvement. At LFU, Group A ODI mean was 14 points or minimal disability, with a 39-point improvement, and Group B improved 28 points to 29 but remained moderately disabled. At LFU, the lumbar stenosis with laminectomy and BVNA subgroup of 26 had mean VAS 2 cm and ODI 28-point improvement but remained on average 21 points with a final low moderate disability. Eleven laminectomy and BVNA patients had continued posterior column pain related to radiculopathy, and or peripheral neuropathy, and sacroiliac joint pain in 30%. Mobile spondylolisthesis in 21 patients in Group B at LFU had a 6 cm improvement of VAS and 25-point improvement of ODI but remained moderately disabled on ODI. At LFU in group B, there was a 20% incidence of continued stenosis and radiculopathy symptoms. At LFU, Lumbar fusion was recommended in 9. Vertebral compression fracture (VCF) occurred in 9 after BVNA (10%) of Group B. These patients were older (mean 78 years), and all had significant osteoporosis. Eight fractures were within the area of the BVNA, and 1 was an S2 sacral fracture. These VCF patients were treated with vertebroplasty or kyphoplasty and continued preventive care with added teriparatide. At LFU, the VCF subgroup had a modest 6 cm improvement in VAS to 4 cm and continued to have significant severe to moderate disability (Oswestry Disability Index average of 38 points).

Conclusion: Clinical trials of BVNA treatment of CLBP found success and durability for pain relief and daily activities. Patients with ASD without comorbidities showed durable pain relief of vertebrogenic CLBP and return of daily activities similar to clinical trials. In those with comorbidities, the result was an improvement in pain and disability that could be diminished by the complications related to the comorbidities. This is new information about BVNA for older patients with spinal deformity and other comorbidities. This study could impact research practice and policy to expand indications of BVNA to patients with adult spinal deformity.

Clinical relevance: This case series represents the only literature regarding patients with adult spinal deformity treated with BVNA. The results were predictable and reproducible. Many patients were satisfied, would have the procedure again and would recommend BVNA to friends and family. This finding should encourage acceptance of patients with ASD for BVNA and, in fact, BVNA should probably be done before any fusion to limit and choose levels for inclusion in fusion.

Level of evidence: 4:

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
期刊最新文献
Beyond the Limits to Become a Leading Force in Global Spine Surgery: Present and Future of Spine Surgery in Asia-Pacific. Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study. Editorial: Embracing Rasch Analysis for Enhanced Spine Surgery Outcomes-The Outsider's Viewpoint. Editors' Introduction: High-Value Endoscopic Techniques: Integrating Surgeon Skill and Experience in Spine Surgery With Rasch Analysis. Invited Commentary: Rasch Analysis and High-Value Spinal Endoscopy.
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