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Rachdi O, Stephens A, Cooper AN, Martin B, Burnham R, Conger AM, McCormick ZL, Burnham TR. A retrospective single arm cohort study evaluating the efficacy of lumbar medial branch radiofrequency ablation using a multi-tined probe and perpendicular approach. INTERVENTIONAL PAIN MEDICINE 2025; 4:100575. [PMID: 40230588 PMCID: PMC11995740 DOI: 10.1016/j.inpm.2025.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Accepted: 03/09/2025] [Indexed: 04/16/2025]
Abstract
Summary of background data Lumbar medial branch radiofrequency ablation (LMBRFA) is an effective treatment for facet joint pain. LMBRFA efficacy was originally demonstrated using a parallel technique. Newly developed RFA probes (e.g., Trident) allow a perpendicular approach (P-LMBRFA), which may simplify the RFA technique and lead to superior treatment success rates. However, further investigation is necessary to determine whether these technologies are associated with improved patient outcomes. Objectives Evaluate the effectiveness of P-LMBRFA in patients with confirmed facet pain. Methods In this retrospective single-arm cohort study, electronic medical records were used to identify consecutive patients with ≥80 % dual medial branch block-confirmed pain relief who underwent first-time P-LMBRFA between 2016 and 2022. Primary outcomes were ≥50 % Numerical Rating Scale (NRS) pain improvement and the minimal clinically important difference (MCID) on the Pain Disability Quality-of-Life Questionnaire (PDQQ) at 3 months post-treatment. Secondary outcomes included the duration and mean retrospective percentage of pain relief after a successful index P-LMBRFA in individuals who reported a return of their index symptoms. Results 174 participants (60.3 % female, 61.3 ± 14.2 years of age, BMI 29.5 ± 6.7 kg/m2) were analyzed. Success rates for ≥50 % NRS reduction and MCID on the PDQQ at 3 months were 50.6 % (95 % CI = 43.3-57.9 %) and 50.0 % (95 % CI = 42.8-57.2 %), respectively. Of the 88 successful P-LMBRFAs, 60 patients experienced a return of symptoms after 8.7 ± 3.6 months and reported a retrospective mean percentage pain relief of 81.8 % ± 15.8 %. Discussion/conclusion Following P-LMBRFA, approximately 50 % of patients reported improvement in pain and disability measures. Extensive, prospective research comparing long-term outcomes of P-LMBRFA and parallel LMRBFA is warranted.
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Affiliation(s)
- Omar Rachdi
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Andrew Stephens
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda N. Cooper
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Brook Martin
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Robert Burnham
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Central Alberta Pain and Rehabilitation Institute, Lacombe, AB, Canada
- Vivo Cura Health, Calgary, AB, Canada
| | - Aaron M. Conger
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Zachary L. McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Taylor R. Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
- Vivo Cura Health, Calgary, AB, Canada
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Kapoor T, Girgis G. A Novel Fluoroscopic Methodology for Accurate and Precise Lumbar Facet Medial Branch Radiofrequency Ablations: An Educational Report. A A Pract 2025; 19:e01955. [PMID: 40178130 DOI: 10.1213/xaa.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025]
Abstract
Although fluoroscopic-guided lumbar facet medial branch radiofrequency ablations (LFMBRFAs) are commonly performed for lumbar spondylosis, literature describing techniques and methods focused on accuracy and precision is scarce. In this case report, we describe an innovative fluoroscopic methodology to help improve LFMBRFA procedural accuracy and precision. A 74-year-old man with a pertinent history of lumbar spondylosis presented with chronic bilateral low axial back pain underwent successful, and uncomplicated bilateral LFMBRFAs. The patient reported 90% to 100% analgesic relief at 6 months follow-up. He did not report any adverse events or complications.
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Affiliation(s)
- Trishul Kapoor
- From the Department of Pain Management, Cleveland Clinic, Cleveland, Ohio
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Jones-Whitehead C, Tran J, Wilson TD, Loh E. Evaluation of a novel nerve ablation technique to relieve lower back pain: a cadaveric feasibility pilot study. PAIN MEDICINE (MALDEN, MASS.) 2025; 26:70-75. [PMID: 39504454 PMCID: PMC11789780 DOI: 10.1093/pm/pnae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/06/2024] [Accepted: 10/24/2024] [Indexed: 11/08/2024]
Abstract
INTRODUCTION Radiofrequency ablation is a treatment for facetogenic low back pain that targets medial branches of lumbar dorsal rami to denervate facet joints. Clinical outcomes vary; optimizing cannula placement to better capture the medial branch could improve clinical outcomes. A novel parasagittal technique was proposed from an anatomic model; this technique was proposed to optimize capture of the medial branch. The anatomic feasibility of the novel technique has not been evaluated. OBJECTIVE To simulate and evaluate the proposed parasagittal technique in its ability to achieve proper cannula placement and proximity of uninsulated cannula tips to the medial branches of the dorsal rami in cadaveric specimens. METHODS Under fluoroscopic guidance, the parasagittal technique was used to place 14 cannulae targeting the lumbar medial branches of 2 cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves with a digital caliper. RESULTS The novel parasagittal technique was successfully performed in a cadaveric model in 12 of 14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In 2 instances, cannulae were placed unsuccessfully; in one instance, the cannula was too far anterior, and in the other, it was too far retracted. CONCLUSION In this cadaveric simulation study, the feasibility of performing the parasagittal technique for lumbar radiofrequency ablation was evaluated. This study suggests that the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Charlotte Jones-Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Tran
- Surgery (Division of Anatomy), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Timothy D Wilson
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
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Tran J, Alboog A, Barua U, Billias N, Loh E. Optimal caudal needle angulation for lumbar medial branch denervation: A 3D cadaveric and clinical imaging comparison study. INTERVENTIONAL PAIN MEDICINE 2024; 3:100433. [PMID: 39502907 PMCID: PMC11536316 DOI: 10.1016/j.inpm.2024.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 11/08/2024]
Abstract
Background Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. The consensus among spine pain interventionalists is that capturing a greater length of the MB correlates with a longer duration of pain relief. Therefore, there has been interest in defining optimal needle angles to achieve parallel cannula placement. Presently, there is inconsistency regarding the optimal caudal needle angles. Objectives The objectives of this study were to: 1) use a dissection-based 3D modelling methodology to quantify optimal caudal needle angles from cadaveric models; and 2) compare optimal cadaver-derived caudal needle angles with real-world patient-derived needle angles. Methods Eighteen formalin embalmed lumbosacral spine specimens were dissected, digitized, and modelled in 3D. Virtual needles were simulated and placed parallel with the L1-L5 MBs. Cadaver-derived caudal needle angles were measured from the high-fidelity 3D models with optimally placed virtual needles. Lateral fluoroscopic images of patients (n = 200) that received lumbar MB denervation were reviewed to measure patient-derived caudal needle angles (L3-L5 MB levels). Descriptive statistics were used to analyze the cadaver (L1-L5 MB levels) and patient-derived (L3-L5 MB levels) caudal needle angles. The cadaver and patient-derived mean caudal needle angles for L3-L5 MB levels were compared. Results There was variability in the cadaver-derived mean caudal needle angles. The lowest mean caudal needle angle was the L1 MB level measured at 41.57 ± 8.56° (range: 27.14° - 53.96°). The highest was the L5 MB level with a mean caudal needle angle of 60.79 ± 8.55° (range: 46.97° - 79.74°). A total of 123 patients were included and 369 caudal needle angles (L3-L5 MB levels) were measured and analyzed. There was variability in the patient-derived mean caudal needle angles. The patient-derived mean caudal needle angles were 29.18 ± 8.77° (range: 11.80° - 61.31°), 33.34 ± 7.23° (range: 16.40° - 54.15°), and 49.08 ± 8.87° (range: 26.45° - 76.95°) for the L3, L4, and L5 MB levels, respectively. There was a significant difference in mean caudal needle angle between cadaver and patient-derived needle angles at the L3, L4, and L5 MB levels. Conclusions Analysis of cadaver-derived needle angles versus patient-derived data suggests optimization of lumbar MB denervation requires greater caudal angulation to achieve parallel needle placement. Further research is required to assess the clinical implications.
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Affiliation(s)
- John Tran
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Abdulrahman Alboog
- Department of Anesthesia and Perioperative Medicine, Western University, London, Canada
- Department of Anesthesia, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Ujjoyinee Barua
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Nicole Billias
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Canada
- Lawson Health Research Institute, London, Canada
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Tran J, Lawson A, Agur A, Loh E. Parasagittal needle placement approach for lumbar medial branch denervation: a brief technical report. Reg Anesth Pain Med 2024; 49:609-614. [PMID: 38176741 DOI: 10.1136/rapm-2023-105152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
Radiofrequency denervation of lumbar medial branches is a viable treatment option to manage chronic facetogenic low back pain. Traditionally, lumbar medial branch denervation involves placement of the electrode's active tip at a 20-degree angulation away from the parasagittal plane. However, more recent anatomical studies have provided evidence supporting the feasibility of an alternative parasagittal approach targeting the posterior half of the lateral neck of the superior articular process to capture the lumbar medial branches. Currently, there is a lack of clinical data on the effectiveness of the alternative parasagittal needle placement technique. Therefore, in this brief technical report, the parasagittal needle placement technique and the pain relief outcomes in four consecutive patients following treatment with the parasagittal approach are described.
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Affiliation(s)
- John Tran
- Surgery (Division of Anatomy), University of Toronto, Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
| | - Arden Lawson
- Lawson Health Research Institute, London, Ontario, Canada
| | - Anne Agur
- Surgery (Division of Anatomy), University of Toronto, Toronto, Ontario, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Tran J, Lawson A, Billias N, Loh E. 3D nerve proximity mapping of the medial branch of lumbar dorsal ramus: An anatomical study. INTERVENTIONAL PAIN MEDICINE 2024; 3:100414. [PMID: 39238583 PMCID: PMC11372964 DOI: 10.1016/j.inpm.2024.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 09/07/2024]
Abstract
Objective Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. Consensus among spine pain interventionalists is that the cannula tip should be placed adjacent to the periosteum of the lateral neck of the superior articular process (SAP) to ensure maximum contact with the MB. The spatial relationship of the nerve to the periosteum of the lateral neck of the SAP has not been quantified in 3D. The objectives of the current study were to: 1) use 3D modelling technology to quantify the location along the lateral neck of the SAP where the MB is in direct contact with the periosteum; and 2) identify target site(s) to optimize lumbar MB denervation. Design Seventy lumbar dorsal rami in 14 formalin-embalmed specimens were dissected, digitized, and modeled in 3D. The 3D positional data of the MB were used to generate a novel nerve proximity map which provided a method to quantify and visualize the 3D course of the MB in relation to the periosteum of the lateral neck of SAP. The percent of the lateral neck of SAP in contact with the MB was quantified and consistent target site(s) identified. Results There was variability in the percentage of the lateral neck of SAP in contact with the MB. The mean percentage of the lateral neck of SAP in contact with the MB for the L1-L5 levels ranged between 57.39 ± 10.72 % (for L1) to 81.54 ± 10.48 % (for L5). The nerve proximity map showed consistent course of the MB along the posterior portion of the lateral neck of SAP and at a novel target site distal to the mamillo-accessory notch (i.e. sub-mammillary landmark). Conclusion The percent of the lateral neck that was in contact with the MB was quantified and visualized using a novel nerve proximity mapping methodology which may be used to inform cannula tip depth placement. Further, the nerve proximity maps were used to identify an alternative landmark to extend the length of the MB captured. The proposed sub-mammillary landmark may be a viable target site pending future anatomical and clinical investigations.
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Affiliation(s)
- John Tran
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Arden Lawson
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Nicole Billias
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, Schulich School of Medicine and Dentistry, London, Ontario, N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
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Tran J, Campisi E, Roa Agudelo A, Agur AM, Loh E. High-fidelity 3D modelling of the lumbar dorsal rami. INTERVENTIONAL PAIN MEDICINE 2024; 3:100401. [PMID: 39239499 PMCID: PMC11373041 DOI: 10.1016/j.inpm.2024.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 09/07/2024]
Abstract
Objective Lumbar medial branch denervation is commonly used to treat chronic facetogenic low back pain. Controversy exists regarding risk to adjacent neural structures. The objectives of this cadaveric study were to: (1) dissect, digitize, and model in 3D the branches of the first (L1) to fifth (L5) lumbar dorsal rami located near the junction of the transverse process and lateral neck of the superior articular process; and (2) quantify the minimal distance between the lateral/intermediate and medial branches at the anterior quarter and midpoint of the lateral neck of the superior articular process. Design Eighteen formalin-embalmed specimens were dissected, digitized and modeled in 3D. The high-fidelity 3D models were used to compare branching patterns and quantify the mean minimal distance between the lateral/intermediate and medial branches of the lumbar dorsal ramus at the anterior quarter and midpoint of the lateral neck of the superior articular process. A Two-way ANOVA was performed to determine if difference of mean distances was significant. Results There was variability in the branching pattern of the lumbar dorsal rami. In 46 cases (51.1%) the lumbar dorsal ramus divided into 2 branches, in 41 cases (45.6%) into 3, and in 3 cases (3.3%) 4. The mean minimal distance between the lateral/intermediate and medial branches was significantly greater at the midpoint (3.2 ± 2.5 mm) than the anterior quarter (1.2 ± 1.8 mm) of the lateral neck of superior articular process. Conclusion Minimal distance measurements between the branches of the lumbar dorsal rami at the anterior quarter and midpoint of the lateral neck of the superior articular process were computed. When placing the distal end of the needle tip at the anterior quarter of the lateral neck of the superior articular process, the smaller mean minimal distance between the branches suggests there is a greater risk for inadvertent denervation of the lateral/intermediate branches. Further anatomical and clinical investigations are required.
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Affiliation(s)
- John Tran
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, N6C 0A7, Canada
- Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Emma Campisi
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Alexandria Roa Agudelo
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, N6C 0A7, Canada
- Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
| | - Anne Mr Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, N6C 0A7, Canada
- Lawson Health Research Institute, London, Ontario, N6C 2R5, Canada
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Tran J, Campisi ES, Agur AMR, Loh E. Quantification of needle angles for lumbar medial branch denervation targeting the posterior half of the superior articular process: an osteological study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:13-19. [PMID: 37578435 DOI: 10.1093/pm/pnad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lumbar medial branch radiofrequency ablation (RFA) is a common intervention to manage chronic axial low back pain originating from the facet joints. A more parasagittal approach targeting the posterior half of the lateral neck of superior articular process (SAP) was previously proposed. However, specific needle angles to achieve parallel placement at this target site have not been investigated. OBJECTIVE To quantify and compare the needle angles, on posterior and lateral views, to achieve parallel placement of electrodes along the medial branch at the posterior half of the lateral neck of SAP at each lumbar vertebral level (L1-L5) and sacrum. DESIGN Osteological Study. METHODS Twelve disarticulated lumbosacral spines (n = 72 individual bones) were used in this study. Needles were placed along the periosteum of the posterior half of the lateral neck of SAP, bilaterally and photographed. Mean needle angles for each vertebral level (L1-L5) and sacrum were quantified, and statistical differences were analyzed. RESULTS The posterior view provided the degrees of lateral displacement from the parasagittal plane (abduction angle), while the lateral view provided the degrees of declination (cranial-to-caudal angle) of the needle. Mean needle angles at each level varied, ranging from 5.63 ± 5.76° to 14.50 ± 14.24° (abduction angle, posterior view) and 40.17 ± 7.32° to 64.10 ± 9.73° (cranial-to-caudal angle, lateral view). In posterior view, a < 10-degree needle angle interval was most frequently identified (57.0% of needle placements). In lateral view, the 40-50-degree (L1-L2), 50-60-degree (L3-L5), and 60-70-degree (sacrum) needle angle intervals occurred most frequently (54.2%, 50.0%, and 41.7% of needle placements, respectively). CONCLUSIONS Targeting the posterior half of the lateral neck of SAP required <10-degree angulation from parasagittal plane in majority of cases. However, variability of needle angles suggests a standard "one-size-fits-all" approach may not be the optimal technique.
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Affiliation(s)
- John Tran
- Department of Physical Medicine and Rehabilitation, Western University, London, ON N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, ON N6C 0A7, Canada
| | - Emma S Campisi
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, ON N6C 0A7, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, ON N6C 0A7, Canada
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Van den Heuvel SAS, Cohen SPC, de Andrès Ares J, Van Boxem K, Kallewaard JW, Van Zundert J. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24:160-176. [PMID: 37640913 DOI: 10.1111/papr.13287] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. METHODS The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. RESULTS There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. CONCLUSIONS Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Sandra A S Van den Heuvel
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Koen Van Boxem
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Rivers WE, Bryant D, Dovgan J, Corduan J. Letter to the Editor regarding "Quantification of needle angles for traditional lumbar medial branch radiofrequency ablation: an osteological study". PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1124-1125. [PMID: 37144965 DOI: 10.1093/pm/pnad054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Affiliation(s)
- William E Rivers
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, United States
- Physical Medicine and Rehabilitation Service, Tennessee Valley Healthcare System, Veterans Affairs, Murfreesboro, TN 37129, United States
| | - Douglas Bryant
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Jakob Dovgan
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, United States
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Tran J, Loh E. Reply to Letter to the Editor regarding "Quantification of needle angles for traditional lumbar medial branch radiofrequency ablation: an osteological study". PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1126. [PMID: 37144956 DOI: 10.1093/pm/pnad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Affiliation(s)
- John Tran
- Department of Physical Medicine and Rehabilitation, Western University, London, ON N6C 5J1, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, ON N6C 0A7, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, Western University, London, ON N6C 5J1, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, ON N6C 0A7, Canada
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Dovgan J, Bryant D, Rivers WE. Letter to editor regarding "Characterizing an angle of cannula insertion for lumbar medial branch radiofrequency neurotomy: A retrospective observational study". INTERVENTIONAL PAIN MEDICINE 2023; 2:100238. [PMID: 39239602 PMCID: PMC11372929 DOI: 10.1016/j.inpm.2023.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/13/2023] [Indexed: 09/07/2024]
Affiliation(s)
- Jakob Dovgan
- Vanderbilt University Medical Center, Department of Physical Medicine and Rehabilitation, United States
| | - Douglas Bryant
- Vanderbilt University Medical Center, Department of Physical Medicine and Rehabilitation, United States
| | - William E Rivers
- Vanderbilt University Medical Center, Department of Physical Medicine and Rehabilitation, United States
- Tennessee Valley Healthcare System, Veterans Affairs, Physical Medicine and Rehabilitation Services, United States
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