Rev. Soc. Esp. Dolor. 2022; 29(3): 169-174 / DOI: 10.20986/resed.2022.4044/2022
Juan Carlos Acevedo, Álex Taub
ABSTRACT
Introduction: Vertebrogenic low back pain is a new concept added to the other pre-existing semiological and pathophysiological forms of pain in this region. It is produced by a lesion in the cartilaginous vertebral plate. As a result of this new concept, novel therapeutic strategies such as percutaneous thermorizotomy of the basivertebral nerve have emerged.
Objectives: The main objective of this study is to evaluate the clinical outcomes of patients with a diagnosis of vertebrogenic pain who were treated with percutaneous basivertebral nerve thermorizotomy (BVN). Pain response, functionality and quality of life will be analyzed.
Methods: Under the parameters of the PRISMA methodology, a search was performed in the Pubmed and Embase databases with the terms “Intraosseous basivertebral nerve ablation”, “Basivertebral nerve AND Intracept”, “INTRACEPT”, “Intraosseous basivertebral nerve ablation AND Intracept”, “vertebrogenic low back pain”. After the search, the articles were initially reviewed independently by each of the authors, repeated articles were filtered out, obtaining 8 population-based studies. Considering the small number of studies, all those presenting a population analysis were included.
Results: The Oswestry Disability Index (ODI) was affected prior to the procedure in most of the patients who underwent percutaneous thermorizotomy of the BVN, with a baseline score of 45.37, which decreased at 3 months to 20.65, 18.6 at 6 months, 17.38 at 9 months, 18.62 at 12 months, 16 at 24 months and 17.05 at 5 years.
As for the Visual Analog Scale (VAS), the baseline score in the population treated with NBV thermorizotomy was 6.61, 3.56 at 3 months, 3.05 at 6 months, 2.6 at 9 months, 3.06 at 12 months, 2.5 at 24 months and 2.48 at 5 years. Obtaining similar results to the most recently published systematic review on the subject.
Discussion: The new concept of vertebrogenic pain seems interesting. It is difficult to understand why cartilaginous vertebral plates had not previously been given pathophysiological importance. Being a new concept, it remains to be confirmed whether it is a different entity from discogenic pain, or on the contrary, both are one and the same. Likewise, the anatomical importance of BVN and consequently its treatment with radiofrequency to control low back pain has arisen. Preliminary studies confirm the existence of this form of pain and the good results, even in the long term, of treatment with the INTRACEPT device.
Conclusions: Vertebrogenic low back pain is a new concept. It is the cause of pain in an important group of patients and is treatable by means of a percutaneous radiofrequency procedure. More studies are still needed to confirm its existence and its treatment.
RESUMEN
Introducción: El dolor lumbar vertebrogénico es un concepto nuevo que se agrega a las otras formas semiológicas y fisiopatológicas preexistentes de dolor en esta región. Se produce por una lesión en los platillos vertebrales cartilaginosos. A raíz de este nuevo concepto han surgido estrategias terapéuticas novedosas como la termorizotomía percutánea del nervio basivertebral.
Objetivos: El objetivo principal de este estudio es evaluar los resultados clínicos de los pacientes con diagnóstico de dolor vertebrogénico que fueron tratados con termorizotomía percutánea del nervio basivertebral (NBV). Se analizará la respuesta del dolor, la funcionalidad y la calidad de vida.
Métodos: Bajo los parámetros de la metodología PRISMA se realizó una búsqueda en las bases de datos Pubmed y Embase con los términos “Intraosseous basivertebral nerve ablation”, “Basivertebral nerve AND Intracept”, “INTRACEPT“, “Intraosseous basivertebral nerve ablation AND Intracept”, “vertebrogenic low back pain”. Posterior a la búsqueda, los artículos fueron inicialmente revisados de manera independiente por cada uno de los autores, se filtraron los artículos repetidos, obteniendo 8 estudios poblacionales. Considerando la poca cantidad de estudios, se incluyeron todos aquellos que presentaran un análisis poblacional.
Resultados: El Oswestry Disability Index (ODI) se vio afectado previo al procedimiento en la mayoría de los pacientes intervenidos con la termorizotomía percutánea del NBV, cursando con un puntaje basal de 45,37, el cual fue disminuyendo a los 3 meses a 20,65, 18,6 a los 6 meses, 17,38 a los 9 meses, 18,62 a los 12 meses, 16 a los 24 meses y 17,05 a los 5 años.
En cuanto a la escala visual análoga (EVA), el puntaje basal en la población intervenida con termorizotomía del NBV fue de 6,61, 3,56 a los 3 meses, 3,05 a los 6 meses, 2,6 a los 9 meses, 3,06 a los 12 meses, 2,5 a los 24 meses y 2,48 a los 5 años. Obteniendo resultados similares a la revisión sistemática más recientemente publicada acerca del tema tratado.
Discusión: Parece interesante el nuevo concepto de dolor vertebrogénico. Es difícil de entender por qué anteriormente no se le había dado importancia fisiopatológica a los platillos vertebrales cartilaginosos. Al ser un concepto nuevo, queda aún por confirmar si es una entidad diferente al dolor discogénico o, por el contrario, ambos constituyen una sola. Igualmente surge la importancia anatómica del NBV y de manera consecuente su tratamiento con radiofrecuencia para controlar el dolor lumbar. Los estudios preliminares confirman la existencia de esta forma de dolor y los buenos resultados, incluso a largo plazo, del tratamiento con el dispositivo INTRACEPT.
Conclusiones: El dolor lumbar vertebrogénico es un concepto nuevo. Es la causa del dolor en un grupo importante de pacientes y es tratable mediante un procedimiento percutáneo por radiofrecuencia. Son necesarios aún más estudios para confirmar su existencia y su tratamiento.
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Bibliografía
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