Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Management of lumbar zygapophysial (facet) joint pain

AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: 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, clinicaltrials.gov, 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: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.

Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

经穴位至关节突注射臭氧水配合推拿、针刺对关节突源性腰痛的影响

目的:观察经穴位至关节突注射臭氧水配合推拿、针刺治疗关节突源性腰痛的临床效果。方法:前瞻性选取河南中医药大学第三附属医院收治的符合纳入标准的106例关节突源性腰痛患者为研究对象,依据随机数字表随机分为研究组53例和对照组53例。对照组接受推拿、针刺治疗,研究组接受经穴位至关节突注射臭氧水配合推拿、针刺治疗,均治疗3个疗程。比较两组疗效、不良反应与复发率,以及治疗不同时间点疼痛程度(VAS评分)、腰椎功能障碍评分(ODI评分)和生活质量评价量表评分(SF-36评分)差异。结果:治疗后,两组临床疗效比较差异有统计学意义(Z=2.572,P<0.05),研究组总优良率88.68%(47/53)高于对照组71.7%(38/53),复发率7.55%(4/53)低于对照组22.64%(12/53)(P<0.05)。两组VAS评分和ODI评分的时点效应、组间效应、交互效应比较,差异有统计学意义(P<0.05),两组治疗1个疗程后、治疗3个疗程后VAS评分和ODI评分均低于治疗前(P<0.05),且研究组治疗1个疗程后、治疗3个疗程后VAS评分和ODI评分均低于对照组(P<0.01)。治疗期间两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。两组治疗后生活质量评价量表(SF-36)各维度得分(躯体疼痛、社会功能、精神健康、生理职能、情感职能、生理功能、精力)均高于治疗前(P<0.05),且研究组治疗3个疗程后SF-36量表各项得分均高于对照组(P<0.05)。结论:经穴位至关节突注射臭氧水配合推拿、针刺治疗关节突源性腰痛具有较好临床疗效,可有效降低复发率,改善疼痛程度与腰椎功能障碍,提高生活质量,且安全性较好。

髋关节置换术后腰椎骨盆矢状位参数变化与小关节源性腰痛的相关性研究

目的探讨髋关节骨性关节炎患者髋关节置换术后腰椎骨盆矢状位参数变化与小关节源性腰痛的关系。方法回顾性分析2019年6月至2020年11月我院骨科收治的30例髋关节骨性关节炎引起小关节源性腰痛且行单侧髋关节置换术治疗患者(观察组)的临床资料;随机选取同期在我院体检中心接受腰椎X射线片检查的50名健康受试者作为对照组。基于X射线片测量腰椎骨盆矢状位参数,包括骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、骶骨骨盆角(SPI)、骶骨骨盆后角(SPPA)。多元线性回归分析腰椎骨盆矢状位参数变化与小关节源性腰痛的相关性,采用受试者工作特征(ROC)曲线分析其对小关节源性腰痛的诊断效能。结果观察组患者术前及术后1年PI、LL、SPI、SPPA与对照组比较差异无统计学意义(P>0.05)。观察组患者术前PT小于对照组(P<0.05),术前SS大于对照组(P<0.05)。多元线性回归分析显示,术前PT、SS与小关节源性腰痛相关(P<0.05)。术前PT和SS诊断小关节源性腰痛的敏感度分别为50.00%、73.30%,特异度分别为88.00%、78.00%。ROC曲线分析显示,术前PT和SS诊断小关节源性腰痛的曲线下面积分别为0.708(95%CI:0.595~0.822)和0.775(95%CI:0.673~0.877)。结论髋关节骨性关节炎患者的SS明显较大,PT明显较小。髋关节置换术可以减轻腰痛症状,且不影响腰椎和骨盆的矢状位平衡;术前PT、SS与小关节源性腰痛具有相关性,二者在诊断小关节源性腰痛方面具有较高的价值。

Association between facet joint osteoarthritis and the Oswestry Disability Index

AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman's coefficient of rank correlation was used for statistical analysis,with significance set at P < 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients' disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.

Does therapist's attitude affect clinical outcome of lumbar facet joint injections?

AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.

Magnetic resonance imaging-based interpretation of degenerative changes in the lower lumbar segments and therapeutic consequences

Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain(LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-toapply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intraarticular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.

Zygapophysial joint pain in selected patients

The zygapophysial joints(z-joints), together with the intervertebral disc, form a functional spine unit. The joints are typical synovial joints with an innervation from two medial branches of the dorsal rami. The joint capsule and the surrounding structures have an extensive nerve supply. The stretching of the capsule and loads being transmitted through the joint can causepain. The importance of the z-joints as a pain generator is often underestimated because the prevalence of z-joint pain(10%-80%) is difficult to specify. Z-joint pain is a somatic referred pain. Morning stiffness and pain when moving from a sitting to a standing position are typical. No historic or physical examination variables exist to identify z-joint pain. Also, radiologic findings do not have a diagnostic value for pain from z-joints. The method with the best acceptance for diagnosing z-joint pain is controlled medial branch blocks(MBBs). They are the most validated of all spinal interventions, although false-positive and false-negative results exist and the degree of pain relief after MBBs remains contentious. The prevalence of z-joint pain increases with age, and it often comes along with other pain sources. Degenerative changes are commonly found. Z-joints are often affected by osteoarthritis and inflammatory processes. Often additional factors including synovial cysts, spondylolisthesis, spinal canal stenosis, and injuries are present. The only truly validated treatment is medial branch neurotomy. The available technique vindicates the use of radiofrequency neurotomy provided that the correct technique is used and patients are selected rigorously using controlled blocks.

CT-Guided Lumbar Facet Joint Infiltration: Accessibility, Accuracy and Functional Outcome

Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure;85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique;CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.

体外冲击波联合艾灸治疗腰椎小关节源性腰痛疗效观察

目的探讨体外冲击波联合艾灸治疗腰椎小关节源性腰痛的疗效。方法选择2020年1月至2022年7月新乡医学院第一附属医院收治的90例腰椎小关节源性腰痛患者为研究对象,采用随机数字表法将患者分为冲击波治疗组、艾灸治疗组、联合治疗组,每组30例。冲击波治疗组患者在腰痛处给予体外冲击波治疗;艾灸治疗组患者在腰痛处给予艾灸治疗;联合治疗组患者在腰痛处给予体外冲击波治疗和艾灸治疗。分别于治疗前及治疗1、2、3、4周后,采用疼痛视觉模拟评分法(VAS)评估3组患者的腰痛程度,日本骨科协会评估治疗(JOA)评分评估3组患者腰部功能障碍情况,Oswestry功能障碍指数(ODI)评估3组患者腰椎功能改善程度。结果治疗前,3组患者VAS、JOA和ODI评分比较差异无统计学意义(P>0.05)。治疗1、2、3、4周后,联合治疗组患者的VAS、JOA评分显著低于冲击波治疗组和艾灸治疗组,ODI评分显著高于冲击波治疗组和艾灸治疗组(P<0.05);冲击波治疗组与艾灸治疗组患者的VAS、JOA和ODI评分比较差异无统计学意义(P>0.05)。3组患者治疗1、2、3、4周后的VAS和JOA评分显著低于治疗前,ODI评分显著高于治疗前(P<0.05)。结论体外冲击波及艾灸均可减轻腰椎小关节源性腰痛,改善腰椎功能;体外冲击波与艾灸联合治疗较单一治疗效果更佳。

富血小板血浆治疗在腰痛的应用与研究进展

腰痛(LBP)是一种常见的临床症状,也是导致残疾和功能障碍的主要原因之一。在骨关节所致LBP的病因中以退行性病变占多数,其中椎间盘退变为主要诱因,还涉及腰椎小关节、骶髂关节、尾骨的病变等。LBP治疗方式从保守治疗过度到手术治疗,疼痛缓解为大多数患者的结局指标,然而并未起到结构修复的作用。鉴于富血小板血浆(PRP)疗法的再生修复潜力及在临床上的广泛应用,本文回顾了PRP与LBP有关的研究,旨在探索PRP治疗LBP的有效性与安全性及相关的参数指标,加速治疗进展。

射频消融技术治疗腰椎小关节和骶髂关节疼痛的疗效分析:系统回顾和荟萃分析

目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT)、Cochrane Database of Systematic Reviews(CDSR)等数据库,检索射频消融治疗SIJ/LFJ的随机对照研究,进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入9篇随机对照文献和560例患者。Meta分析显示,射频消融可提高SIJ/LFJ患者治疗的临床有效率(OR=16.41,95%CI=2.18~123.28,P=0.007)和优良率(OR=11.94,95%CI=5.02~28.36,P<0.001);射频消融可降低SIJ/LFJ患者的治疗后1周时VAS/NRS评分(WMD=-0.50,95%CI=-0.61~-0.39,P<0.001)、治疗后3个月时VAS/NRS评分(WMD=-1.37,95%CI=-1.82~-0.91,P<0.001)、治疗后6个月时VAS/NRS评分(WMD=-2.25,95%CI=-3.75~-0.75,P=0.003)、治疗后1个月时ODI指数(WMD=-14.86,95%CI=-28.73~-0.99,P=0.04)、治疗后3个月时ODI指数(WMD=-6.00,95%CI=-10.74~-6.53,P=0.01);射频消融对治疗后1 d时VAS/NRS评分(WMD=-0.06,95%CI=-0.35~0.23,P=0.67)、治疗后1个月时VAS/NRS评分(WMD=-0.85,95%CI=-1.91~0.21,P=0.12)和不良反应(OR=0.25,95%CI=0.05~1.29,P=0.10)无显著影响。结论射频消融治疗SIJ/LFJ安全有效。

椎间隙入路关节突外侧开窗对腰椎间盘突出症预后影响

目的:研究分析椎间隙入路关节突外侧开窗对腰椎间盘突出症预后的影响。方法:选取武汉中西医结合骨科医院、长江大学附属荆州医院2020年9月—2022年10月收治的72例腰椎间盘突出症患者,通过随机数字表法将其分为对照组(常规穿刺入路脊柱内镜手术疗法,36例)与观察组(椎间隙入路关节突外侧开窗手术疗法,36例)。研究分析其临床指标、日本骨科协会(Japanese orthopaedic association,JOA)下腰痛评分表评分、视觉模拟评分法(VAS)评分、治疗优良率、腰椎后伸、前屈、左侧屈和右侧屈运动范围的改变。结果:观察组治疗优良率明显高于对照组,差异有统计学意义(P<0.05)。观察组手术时间、住院时间均短于对照组,差异均有统计学意义(P<0.05),两组术中出血量比较差异无统计学意义(P>0.05)。治疗后90 d,观察组VAS评分低于对照组,JOA下腰痛评分表评分高于对照组,差异均有统计学意义(P<0.05)。治疗后90 d,观察组腰椎后伸、前屈、左侧屈及右侧屈运动范围均高于对照组,差异均有统计学意义(P<0.05)。两组术后切口血肿、术后切口感染、神经根或者硬膜撕裂等并发症发生率比较,差异均无统计学意义(P>0.05)。结论:对腰椎间盘突出症实施椎间隙入路关节突外侧开窗治疗方式,临床治疗效果显著,能够明显改善腰椎功能及预后,调整腰椎后伸、前屈、左侧屈及右侧屈运动范围,降低疼痛感。

内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛

目的：探讨内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛的效果。方法：2011年4月～2011年10月，收治58例分别使用利多卡因和布比卡因行对照性脊神经背内侧支封闭术证实疼痛80％以上来源于腰椎关节突关节的慢性腰痛患者，其中45例接受内窥镜下脊神经背内侧支切断术治疗（手术治疗组），其余13例接受药物、理疗及认知治疗等保守治疗（保守治疗组）。封闭前、封闭后、治疗后ld、3个月、6个月及12个月时记录患者腰痛及牵涉痛的VAS评分，术后12个月时行腰椎MacNab功能评分评估两组的疗效．比较两种治疗方法腰痛缓解率的差异。结果：手术治疗组术后ld、3个月、6个月及12个月时腰痛及牵涉痛VAS评分较封闭前均明显降低（P〈0．05），术后各时间点比较无显著性差异（P〉0．05），无手术并发症发生；保守治疗组封闭后腰痛及牵涉痛VAS评分较封闭前明显降低（P〈0．05）．保守治疗组治疗后腰痛及牵涉痛VAS评分较封闭前明显降低（P〈0．05），但均明显高于封闭后VAS评分（P〈0．05）。手术治疗组术后各时间点腰痛及牵涉痛疼痛缓解率均明显高于保守治疗组（P〈0．01）。术后1年随访MacNab功能评分：手术治疗组优27例，良17例，可l例；保守治疗组可6例，差7例。结论：内窥镜下脊神经背内侧支切断术是治疗腰椎关节突关节源性慢性腰痛安全、有效的方法，疗效优于传统保守治疗方法。

腰椎关节突关节骨性关节炎的CT分级及其临床意义

目的:探讨腰椎关节突关节骨性关节炎的CT分级及其临床意义。方法:回顾性分析2008年1月～2010年12月在我院就诊的100例腰痛或腰痛伴下肢麻木疼痛患者的腰椎CT。男43例,女57例;年龄23～81岁,平均52.5岁。采用CT骨窗轴位像关节突关节的关节间隙宽度、骨赘形成及骨质变化情况作为分级依据征象,将每个征象按照其严重程度分为4个等级,相应赋予0～3分,按3个征象总分分为4级:0级,0分;Ⅰ级,1～3分;Ⅱ级,4～6分;Ⅲ级,7～9分。由初、中、高级职称3位医师在PACS系统对100例患者从L1/2至L5/S1节段的双侧关节突关节分别进行2次独立分级,Kappa分析评价3位医师分级结果的一致性。同时对患者腰痛VAS评分、Oswestry功能障碍指数(ODI)和年龄与分级结果进行Spearman相关分析。结果:3位医师分别2次对100例患者的1000个腰椎关节突关节进行分级,0级200～211个(20.0%～21.1%),Ⅰ级384～403个(38.4%～40.3%),Ⅱ级301～310个(30.1%～31.0%),Ⅲ级85～106个(8.5%～10.6%)。同一医师前后分级一致的关节突关节数为84.1%～88.4%,Kappa值为0.773～0.833;不同级别医师分级一致的关节突关节数为82.9%～87.9%,Kappa值为0.756～0.827。患者VAS评分和ODI与分级结果的相关系数分别为0.186、0.192,无显著相关性(P>0.05);年龄与分级结果的相关系数为0.558,呈显著性正相关(P<0.05)。结论:腰椎关节突关节骨性关节炎CT分级具有良好的一致性,对关节突关节退变程度的评估和研究有指导意义;腰椎关节突关节骨性关节炎CT分级与年龄呈正性相关,而与腰痛程度及腰椎ODI无显著相关性。

腰椎侧弯患者关节突关节形态及其临床意义

目的:研究下腰痛患者关节突关节形态与腰椎侧弯的关系。方法:37例腰椎侧弯的下腰痛患者,通过X线摄片和CT轴向扫描,测量L3/4、L4/5、L5/S1关节突关节形态。26例正常者作为对照。结果:在腰椎侧弯患者中L4/5节段关节突关节不对称为72%,L5/S1节段为49%。结论:腰椎侧弯与关节突关节不对称有关,可能是侧方不稳、滑脱的原因。

腰椎小关节周围脊神经后支内侧支分布的特点及其临床意义

目的通过对腰部关节突关节周围脊神经后支内侧支分布解剖观察,探讨去神经术中脊神经后支内侧支的定位和靶点的选择。方法对5具尸体的腰部关节突关节区域进行局部解剖,观察关节突关节周围肌肉的配布情况、脊神经后支的分支情况,脊神经后支内侧支的走行、分支和分布,与上关节突、横突和关节突关节的关系,测量了骨纤维管的内侧开口、关节突关节囊和上关节突距棘突边缘连线的距离。结果关节突关节及周围结构的解剖显示,脊神经后支分出的内侧支紧贴上关节突和横突根部走行,不易探查和解剖;脊神经后支内侧支从骨纤维管穿后,斜向内下方走行,较容易追踪。结论在脊神经后支内侧支从骨纤维管穿后进行去神经操作可以提高去神经术操作安全性和有效性。

椎间孔镜术后副损伤导致腰臀部疼痛原因分析

目的对实施经椎间孔脊柱内镜手术后副损伤分析,以期对临床工作提供参考。方法通过纳入标准、手术标准筛选患者。术后1个月、6个月时进行腰椎稳定性评价,并按术后复查时是否接受逐层阻滞,将患者分为阻滞组与非阻滞组。通过术前1天、术后1周、1. 5个月、3个月、6个月患者的腰痛及下肢VAS及ODI评分,并进行统计分析。结果共68例,男性42例,女性27例,年龄28～53岁,平均年龄38岁,其中腰3/4节段3例,腰4/5节段41例,腰5/骶1节段24例。其中阻滞组43例,非阻滞组25例。术后1个月68例患者无腰椎不稳表现;阻滞组阻滞有效部位集中于椎小关节、纤维环,全部68例患者术前,术后6个月VAS、ODI评分配对t检验,差异有统计学意义(P=0. 000)。术后各随访时间点组间独立样本t检验,差异无统计学意义(P> 0. 05)。结论实施经椎间孔脊柱内镜技术后,椎小关节囊、纤维环的损伤是引发腰臀部疼痛的参与因素,但疼痛程度不影响腰椎功能的恢复。

小关节与腰痛关系的辨析

小关节病变曾被认为是引发非特异性腰痛的主要原因。“小关节综合征”的概念由来已久。但近年来越来越多的事实表明 ,无法找出任何一组临床特征能够从人群中鉴别出“小关节综合征”。小关节性腰痛是存在的 ,而“小关节综合征”并不存在 ,它不能作为一个确定的临床诊断。