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Management of lumbar zygapophysial (facet) joint pain

World Journal of Orthopedics 2016年第5期7卷 315-337页

作者： Laxmaiah Manchikanti Joshua A Hirsch Frank JE Falco Mark V Boswell pain Management Center of Paducah Anesthesiology and Perioperative Medicine University of Louisville NeuroInterventional Services and Neuroen-dovascular Program Massachusetts General Hospital Harvard Medical School mid atlantic spine and pain physicians pain Medicine Fellowship Program Temple University Hospital

AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back ***: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, ***, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Acro

关键词： Chronic low back pain Lumbar facet joint pain Lumbar discogenic pain Intraarticular injections Lumbar facet joint nerve blocks Lumbar facet joint radiofrequency Controlled diagnostic blocks Lumbar facet joint

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