Klinische Ergebnisse nach endoskopischer Facettengelenkdenervation bei Patienten mit chronischen Kreuzschmerzen

Abstract

Purpose

Several studies have reported that low back pain has a high prevalence among the population, with up to 85%. Percutaneous radiofrequency facet denervation (PRFD) is the gold standard of today’s rhizotomy for chronic low back pain (CLBP). However, previously published studies present controversial results for the efficacy of PRFD. Therefore, this study aimed to analyse the use of endoscopic facet joint denervation (EFJD) to treat chronic low back pain and to identify potential risk factors that could limit indications for surgery.

Material and Methods

We retrospectively included 31 eligible patients into the study with at least 24 months of CLBP. All patients underwent EFJD and had to complete ODI, COMI, EQ-5D and VRS scores postoperatively, with a minimum follow up of 12 months. Basic patient data was recorded to analyse correlations.

Results

We found a significant improvement in all clinical scores measured, such as ODI, COMI, EQ-5D and VRS scores. While the best result was found at the 3 months follow-up, a slight deterioration was found at 12 months follow-up. However, significant benefit was observed when compared to preoperative scores. 28/31 patients (93.3%) reported reduced pain at 12 months follow-up and were satisfied with the procedure. Older age and psychiatric precondition were identified as potential risk factors associated with poorer outcome. Postoperative complications such as haematoma, a sensibility disorder and temporary low extremity muscular weakness were rarely observed.

Conclusion

EFJD showed significant improvement of the clinical outcome scores and VRS when compared to preoperative results of patients, with a minimum of 12 months of CLBP prior to surgery. Older patients and patients with a psychiatric precondition seem to benefit less from the procedure.

Schlüsselwörter

Facettengelenksdenervation - Endoskopie - chronische Kreuzschmerzen - minimalinvasive Wirbelsäulenchirurgie - Facettengelenksyndrom

• Literatur

• 1 Barelli LP, Dettori NG. [The dark side of facet joint]. Rev Med Suisse 2016; 12: 1222-1224
• 2 Hoy D, Bain C, Williams G. et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012; 64: 2028-2037
• 3 Bishwajit G, Tang S, Yaya S. et al. Participation in physical activity and back pain among an elderly population in South Asia. J Pain Res 2017; 10: 905-913
• 4 Parthan A, Evans CJ, Le K. Chronic low back pain: epidemiology, economic burden and patient-reported outcomes in the USA. Expert Rev Pharmacoecon Outcomes Res 2006; 6: 359-369
• 5 Koes BW, van Tulder M, Lin CW. et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075-2094
• 6 van Kleef M, Barendse GA, Kessels A. et al. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999; 24: 1937-1942
• 7 Shealy CN. Facet denervation in the management of back and sciatic pain. Clin Orthop Relat Res 1976; (115) 157-164
• 8 Jentzsch T, Sprengel K, Peterer L. et al. 3D navigation of endoscopic rhizotomy at the lumbar spine. J Clin Neurosci 2016; 23: 101-105
• 9 Jeong SY, Kim JS, Choi WS. et al. The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. J Korean Neurosurg Soc 2014; 56: 338-343
• 10 Meloncelli S, Germani G, Urti I. et al. Endoscopic radiofrequency facet joint treatment in patients with low back pain: technique and long-term results. A prospective cohort study. Ther Adv Musculoskelet Dis 2020; 12: 1759720X20958979
• 11 Xue Y, Ding T, Wang D. et al. Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain. J Orthop Surg Res 2020; 15: 4
• 12 van Tilburg CW, Stronks DL, Groeneweg JG. et al. Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain. Bone Joint J 2016; 98-B: 1526-1533
• 13 Leclaire R, Fortin L, Lambert R. et al. 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: 1411-1416
• 14 Fujiwara A, Tamai K, Yamato M. et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999; 8: 396-401
• 15 Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987; 164: 227-320
• 16 Walter SG, Struwe C, Scheidt S. et al. Endoscopic facet joint denervation for treatment of chronic lower back pain. Clin Neurol Neurosurg 2020; 195: 105904
• 17 Li ZZ, Hou SX, Shang WL. et al. Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain. Clin Neurol Neurosurg 2014; 126: 11-17
• 18 Chen CH, Weng PW, Wu LC. et al. Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain: A meta-analysis. Medicine (Baltimore) 2019; 98: e16230
• 19 Moussa WM, Khedr W. Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome. Clin Neurol Neurosurg 2016; 150: 96-104
• 20 Juch JNS, Maas ET, Ostelo RWJG. et al. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials. JAMA 2017; 318: 68-81
• 21 Menendez ME, Neuhaus V, Bot AG. et al. Psychiatric disorders and major spine surgery: epidemiology and perioperative outcomes. Spine (Phila Pa 1976) 2014; 39: E111-122
• 22 Diebo BG, Lavian JD, Murray DP. et al. The Impact of Comorbid Mental Health Disorders on Complications Following Adult Spinal Deformity Surgery With Minimum 2-Year Surveillance. Spine (Phila Pa 1976) 2018; 43: 1176-1183
• 23 Sobottke R, Aghayev E, Röder C. et al. Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry. Eur Spine J 2012; 21: 411-417