Lateral branch neurotomy for sacroiliac joint pain improves pain and physical function .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(14):10 Pain Med. 2012 Mar;13(3):383-98. doi: 10.1111/j.1526-4637.2012.01328.x. Epub 2012 Feb 2Exclusive Author Interview
Dr. Patel discusses the use of lateral branch neurotomy for sacroiliac joint pain improves pain and physical function
51 patients experiencing sacroiliac joint (SIJ) pain were randomized on a 2:1 basis into two groups to either receive lateral branch radiofrequency (RF) neurotomy or a sham treatment. Following assessments over a 9 month period, results indicated that patients who underwent lateral branch RF neurotomy treatment noticed a significant decrease in pain, disability, and an increase in physical function.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Sacroiliac joint (SIJ) pain is a common form of lower back pain. Intra-articular SIJ injections are normally used to treat the condition, but sometimes this method is ineffective or only provides short-term pain relief. Lateral branch RF neurotomy has been suggested as an alternative treatment for SIJ pain, but few studies have assessed the efficacy of this method. This study aimed to determine the effectiveness of lateral branch RF neurotomy in pain management of SIJ pain.
¿Cuál era la pregunta principal de la investigación?
Did lateral branch radiofrequency neurotomy significantly decrease sacroiliac joint pain and increase physical function, when measured over a 9 month period?
- The mean improvement in NRS pain score at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (-2.4 +/- 2.7) than in the Sham group (-0.8 +/- 2.4) (p=0.035)
- The mean improvements in SF-36 for bodily pain at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: 15 +/- 17, Month 3: 16 +/- 26) than in the Sham group (Month 1: 2 +/- 11, Month 3: -1 +/- 13) (Month 1: p=0.006, Month 3: p=0.019)
- The mean improvements in SF-36 for physical function at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: 10 +/- 17, Month 3: 14 +/- 19) than in the Sham group (Month 1: 5 +/- 12, Month 3: 3 +/- 12) (Month 1: p=0.238, Month 3: p=0.040)
- The mean improvements in ODI at the 1 and 3 month assessments were significantly higher in the Lateral Branch Neurotomy group (Month 1: -12 +/- 14, Month 3: -11 +/- 17) than in the Sham group (Month 1: -4 +/- 11, Month 3: 2 +/- 6) (Month 1: p=0.046, Month 3: p=0.011)
- The percentage of patients who had a positive GPE score (positive defined as “pain has decreased a lot”) at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (47%) than in the Sham group (8%) (p<0.05)
- The mean AQoL score at the 3 month assessment was significantly higher in the Lateral Branch Neurotomy group (0.69 +/- 0.21) than in the Sham group (0.56 +/- 0.21) (p=0.048)
¿Qué es lo que más debo recordar?
Patients who underwent lateral branch RF neurotomy experienced significant improvements in SIJ pain, disability, physical function, and quality of living compared to those who underwent the sham treatment.
¿Cómo afectará esto al cuidado de mis pacientes?
Patients who have failed to get pain alleviation after taking intra-articular SIJ injections are may benefit from lateral branch RF neurotomy. Further research with larger sample sizes and longer follow-up are required to confirm the benefits.
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