Indicações da Terapia por Radiofrequência via Percutânea para Tratamento de Dor Lombar - Rizotomia Percutânea Facetária.
Método de pesquisa:
Search MEDLINE/PubMed via PICO with Spelling Checker
Patient, Intervention, Comparison, Outcome
Período de Busca:
Últimos 05 anos (2010-2015)
Patient Problem or Medical Condition: "LUMBAR PAIN"
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Resultados de Busca:
A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions.Hansen H; Manchikanti L; Simopoulos TT; Christo PJ; Gupta S; Smith HS; Hameed H; Cohen SPPain Physician; 2012 May-Jun; 15(3):E247-78. PubMed ID: 22622913
The evidence was fair in favor of cooled radiofrequency neurotomy and limited (or poor) for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.
The role of radiofrequency ablation for sacroiliac joint pain: a meta-analysis.Aydin SM; Gharibo CG; Mehnert M; Stitik TPPM R; 2010 Sep; 2(9):842-51. PubMed ID: 20869684
The meta-analysis demonstrated that RFA is an effective treatment for SI joint pain at 3 months and 6 months. This study is limited by the available literature and lack of randomized controlled trials. Further standardization of RFA lesion techniques needs to be established, coupled with prospective randomized controlled trials.
Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials.Leggett LE; Soril LJ; Lorenzetti DL; Noseworthy T; Steadman R; Tiwana S; Clement FPain Res Manag; 2014 Sep-Oct; 19(5):e146-53. PubMed ID: 25068973
While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short-term follow-up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long-term efficacy of RFA.
Radiofrequency denervation for facet joint low back pain: a systematic review.Poetscher AW; Gentil AF; Lenza M; Ferretti MSpine (Phila Pa 1976); 2014 Jun; 39(14):E842-9. PubMed ID: 24732848[TBL] [Abstract] [Full Text] [Related]
The available evidence reviewed in this study should be interpreted with caution. The data indicate that FJRD is more effective than placebo in pain control and functional improvement and is also possibly more effective than steroid injections in pain control. Complications and adverse effects were not sufficiently reported to allow comparisons, and there was no evidence for cost-effectiveness. High-quality randomized controlled trials addressing pain, function, quality of life, complications, and cost-effectiveness are urgently needed.
An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations.Manchikanti L; Abdi S; Atluri S; Benyamin RM; Boswell MV; Buenaventura RM; Bryce DA; Burks PA; Caraway DL; Calodney AK; Cash KA; Christo PJ; Cohen SP; Colson J; Conn A; Cordner H; Coubarous S; Datta S; Deer TR; Diwan S; Falco FJ; Fellows B; Geffert S; Grider JS; Gupta S; Hameed H; Hameed M; Hansen H; Helm S; Janata JW; Justiz R; Kaye AD; Lee M; Manchikanti KN; McManus CD; Onyewu O; Parr AT; Patel VB; Racz GB; Sehgal N; Sharma ML; Simopoulos TT; Singh V; Smith HS; Snook LT; Swicegood JR; Vallejo R; Ward SP; Wargo BW; Zhu J; Hirsch JAPain Physician; 2013 Apr; 16(2 Suppl):S49-283. PubMed ID: 23615883[TBL] [Abstract] [Full Text] [Related]
I. LUMBAR SPINE
The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair.
The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks.
The evidence is good in managing disc herniation or radiculitis for caudal, interlaminar, and transforaminal epidural injections; fair for axial or discogenic pain without disc herniation, radiculitis or facet joint pain with caudal, and interlaminar epidural injections, and limited for transforaminal epidural injections; fair for spinal stenosis with caudal, interlaminar, and transforaminal epidural injections; and fair for post surgery syndrome with caudal epidural injections and limited with transforaminal epidural injections.
The evidence for therapeutic facet joint interventions is good for conventional radiofrequency, limited for pulsed radiofrequency, fair to good for lumbar facet joint nerve blocks, and limited for intraarticular injections.
For sacroiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy.
For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis.
For intradiscal procedures, the evidence for intradiscal electrothermal therapy (IDET) and biaculoplasty is limited to fair and is limited for discTRODE.
For percutaneous disc decompression, the evidence is limited for automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision.
An update of the effectiveness of therapeutic lumbar facet joint interventions.Falco FJ; Manchikanti L; Datta S; Sehgal N; Geffert S; Onyewu O; Zhu J; Coubarous S; Hameed M; Ward SP; Sharma M; Hameed H; Singh V; Boswell MVPain Physician; 2012 Nov-Dec; 15(6):E909-53. PubMed ID: 23159980[TBL] [Abstract] [Full Text] [Related]
In summary, there is good evidence for the use of conventional radiofrequency neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement.
Pain originating from the lumbar facet joints.van Kleef M; Vanelderen P; Cohen SP; Lataster A; Van Zundert J; Mekhail NPain Pract; 2010 Sep-Oct; 10(5):459-69. PubMed ID: 20667027[TBL] [Abstract] [Full Text] [Related]
Although the existence of a “facet syndrome” had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low-level trauma, leading to inflammation and stretching of the joint capsule. The most frequent complaint is axial low back pain with referred pain perceived in the flank, hip, and thigh. No physical examination findings are pathognomonic for diagnosis. The strongest indicator for lumbar facet pain is pain reduction after anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Because false-positive and, possibly, false-negative results may occur, results must be interpreted carefully. In patients with injection-confirmed zygapophysial joint pain, procedural interventions can be undertaken in the context of a multidisciplinary, multimodal treatment regimen that includes pharmacotherapy, physical therapy and regular exercise, and, if indicated, psychotherapy. Currently, the “gold standard” for treating facetogenic pain is radiofrequency treatment (1 B+). The evidence supporting intra-articular corticosteroids is limited; hence, this should be reserved for those individuals who do not respond to radiofrequency treatment (2 B±).
Utilizando-se do método PICO e considerando a relação dos estudos encontrados com o tema central desta revisão, foram avaliadas as conclusões de 02 metanálises e 05 revisões sistemáticas, publicadas nos últimos 5 anos.
Não ficou demonstrada a eficácia e segurança da denervação
facetaria por radiofreqüência no tratamento da dor lombar a médio e longo
prazo. Em termos de metanálise, o maior follow-up encontrado foi de 3 a 6 meses.
A metanálise mais recente sobre o assunto, datando de 2012, mostra pobre evidência a curto e longo prazo das terapêuticas intra-articulares e peri-articulares, incluindo a radiofrequencia pulsada, convencional e neurotomia.
Pelo expostos, até o presente momento, até que novos estudos estejam disponíveis, a denervação facetária com radiofreqüência no tratamento da dor lombar deve ser considerada uma tecnologia experimental , sendo seu uso reservado para situações de pesquisa e com pleno consentimento do paciente quanto a incerteza dos resultados.
DATA DA REVISÃO: JAN/2015