Background:Patient selection for lumbar medial branch radiofrequency neurotomy (LMBRFN) remains a topic of debate. Different block paradigms may influence LMBRFN outcomes. This study examined the relationships between block paradigms and treatment results following LMBRFN. Methods:A retrospective cohort study of consecutive patients undergoing first-time LMBRFN between 2016 and 2022 at two associated Canadian clinics was performed. Patients were grouped into six prognostic block paradigms based on block type (medial branch block [MBB] vs. intra-articular block [IAB]), number of blocks (single vs. dual), and percent pain relief (50-79% vs. ≥80%): 1 = MBB/MBB ≥80%, 2 = MBB/MBB 50-79%, 3 = IAB/MBB ≥80%, 4 = IAB/MBB 50-79%, 5 = MBB ≥80%, and 6 = MBB 50-79%. Treatment success was defined by (1) ≥50% reduction in numerical rating scale (NRS) pain score and (2) the minimal clinically important difference (MCID) in Pain Disability Quality-of-Life Questionnaire-Spine (PDQQ-S) at 3 months post-procedure. Logistic regression was used to assess associations between block paradigm and outcomes while controlling for select demographic and clinical factors. Results:Among 631 included patients (57.1% female; mean age 62.3 ± 12.9 years), 46.9% achieved ≥50% NRS reduction and 47.7% met the MCID for PDQQ-S at 3 months. No significant associations were found between block paradigms and ≥50% pain relief. However, the IAB/MBB 50-79% paradigm was associated with significantly lower odds of functional improvement by the PDQQ-S (OR = 0.31; p = 0.02). Patients who were working at the time of the procedure had higher odds of treatment success with respect to pain (OR = 2.51; p < 0.01) and function (OR = 2.21; p < 0.01). Conclusion:In this cohort, nearly half of patients experienced clinically meaningful pain reduction at 3 months post-LMBRFN, regardless of block selection criteria, challenging the need for restrictive paradigms. However, patients selected by IAB/MBB with 50-79% pain relief were less likely to experience clinically significant improvements to function. Active employment was linked to better 3-month outcomes for both pain and function, highlighting potential psychosocial factors. Larger prospective studies with long-term follow-up are needed to confirm these findings and optimize patient selection for LMBRFN.
原文链接
分享
引用
