후지내측지에대한경피적고주파신경차단술의예후인자 *

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1 KISEP Clinical Article J Korean Neurosurg Soc , 2003 후지내측지에대한경피적고주파신경차단술의예후인자 * 죠훈 하성곤 김세훈 임동준 박정율 서중근 Prognostic Factors of Percutaneous Radiofrequency Neurotomy on the Posterior Primary Ramus Hoon Joy, M.D., Sung Kon Ha, M.D., Se Hoon Kim, M.D., Dong Jun Lim, M.D., Jung Yul Park, M.D., Jung Keun Suh, M.D. Department of Neurosurgery, Korea University Medical School, Ansan, Korea Objective:We report our experience of percutaneous radiofrequency neurotomy(prn) on the posterior primary ramus with at least two years follow up. Methods:Two hundred and twenty-eight patients were underwent PRN on the posterior primary ramus for refractory low back pain during last three years. One hundred and twenty-eight patients were met all inclusion criteria indicating facetal originated pain(group II), and 100 patients were not(group I). Radiofrequency procedures were done in usual manner. Pain reliefs were estimated at 1 week, 1 month, 6 months and 2 years using visual analog scale. Results:Positive responders were 56% at 1 week, 46% at 1 month, 18% at 6 months, and 13% at 2 years after PRN in group I, and 78.9% at 1 week, 75.4% at 1 month, 62.5% at 6 months, and 54.7% at 2 years in group II. Prominent local tenderness, percussion tenderness, pain on getting up, extension and transitional movement, radiating pain on buttock and/or posterior thigh, and good immediate response were found to be significantly related to outcome. And age, sex, symptom duration, bilateral symptoms, favorable imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not. Conclusion:Percutaneous radiofrequency neurotomy on the posterior primary ramus has long-term beneficial effect, without any morbidity in our series. And the long-term good results will be anticipated after proper selection among patients with facet joints related low back pain. KEY WORDS:Low back pain Radiofrequency neurotomy Posterior primary ramus Facet joint. 서 론 Received:May 18, 2002 Accepted:June 21, 2002 Address for reprints:jung Yul Park, M.D., Department of Neurosurgery, Korea University Medical School, 516 Gojan, Ansan , Korea Tel , Fax jypark@kumc.or.kr 대상 대상및방법 J Korean Neurosurg SocVolume 33January,

2 Table 1. Inclusion criteria for percutaneous radiofrequency neurotomy of posterior primary ramus Group I Group II 01 LBP* with/without leg or radiating pain 6 month of duration 02 No meaningful neurological deficits 03 No significant nerve root or cord compressing signs or instabilities 04 No substantial benefits from intense PT** 46wks 05 50% pain relief from diagnostic ramus blocks 06 Pseudoradicular pain aggravated by extension 07 Pseudoradicular pain aggravated by sign of 4 08 Pseudoradicular pain aggravated by sign of reversed 4 수술방법및과정 09 Local paravertebral tenderness 10Local paravertebral percussion tenderness LBPlower back pain, PTphysical therapy 90 GroupI GroupII 환자군의임상특성 Table 2. Baseline characteristics of patients Characteristics Group In=100 Group IIn=128 Agemean, years Male No.male : female Preoperative pain duration mean, months Previous lumbar op./ 23/523/5 28/621.9/4.7 Instrumentation% Minimal follow upmonths % of positive patients wk 1 mo 6 mo 2 yr Time Fig. 1. Long-term results of percutaneous radiofrequency neurotomy on the posterior primary ramus between Group I/ Group II. Group I indicates those patients without specific clinical symptoms and signs of pain of facetal origin while patients in group II had all of inclusion criteria with symptoms and signs of pain relevant to facetal origin. Long-term results between these two groups show significant difference J Korean Neurosurg SocVolume 33January, 2003

3 임상적평가및통계처리 결 과 고주파열치료후통증경감지속성비교 % of positive patients Not previous OP Previous OP wk 1 mo 6 mo 2 yr Time Fig. 2. Long-term results of percutaneous radiofrequency neurotomy on the posterior primary ramus between previously operated group and not operated group showing no significant difference. Fig. 3. Primary and additional trajectory targets for percutaneous radiofrequency block on the posterior primary rami. Radiofrequency needle is inserted at the point 5 cm lateral to the spinous process maintaining the angle about degree between the needle and horizontal plane, and advanced to the point encountered with superior articular process and transverse processburton s point. p p p 합병증 J Korean Neurosurg SocVolume 33January,

4 고 찰 고주파열치료및후지내측지에대한경피적신경차단술의역사 후지내측지에대한경피적고주파신경차단술의장점 단점과한계및부작용 척추후추간관절에서기인한통증을나타내는평가 Table 3. Advantages of radiofrequency treatment 1 Minimally invasive 2 Well-circumscribed lesions 3 Quantifiable lesion with temperature control 4 Excellent target control with stimulation, impedance monitoring, recording with patients communication 5 Simple, safe, feasible, repeatable 6 Easy adaptation to stereotactic or fixation devices 7 Versatile, robust electrode configurations for numerous clinical indications 8 Cost-effective 9 Applicability, practicality 10 Continuing its refinemente.g., pulsed technique for neuropathic pain 54 J Korean Neurosurg SocVolume 33January, 2003

5 결론 Acknowledgement References 1. Bogduk N:The innervation of the lumbar spine. Spine 8: , Helbig T, Lee CK:The lumbar facet syndrome. Spine 13:61-64, Kirschner M:Zur elektrochirurgie. Arch Klin Chir 167:761, Letcher FS, Goldring S:The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg 29:42-47, Oudenhoven RC:Paraspinal electromyography following facet rhizotomy. Spine 2: , Park JY, Park DH:Radiofrequency treatment for chronic refractory pain. Geriatr Disord 5: , Pernak J:Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use(thesis), Eburon, Delft, Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R: Prevalence and clinical features of lumbar zygapophysial joint pain: A study in an Australian population with chronic low back pain. Ann Rheum Dis 54: , Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N:The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 58: , Shealy CN:Percutaneous radiofrequency denervation of spinal facets: Treatment for chronic back pain and sciatica. J Neurosurg 43: , Sluijter ME:Radiofrequency lesions of the communicating ramus in the treatment of low back pain in Racz GB(ed):Techniques of Neurolysis, Boston:Kluwer, 1989, pp Sluijter ME, Mehta M:Treatment of chronic back and neck pain by percutaneous thermal lesions in Lipton(ed):Persistent pain:modern Methods of Treatment, London:Academic Press, 1981, Vol 3, pp Uematsu S, Udvarhelyi GB, Benson DW, Siebens AA:Percutaneous radiofrequency rhizotomy. Surg Neurol 2: , 1974 J Korean Neurosurg SocVolume 33January,