1
|
Liu Z, Chen J, Fang D, Xu Y, Zhou X, Zheng Z, Zhang Z, Fan C, Luo S, Liu Z, Li Q, Zhao Q. Anatomical Observation and Clinical Significance of the Medial Branch of the Lumbar Dorsal Rami. Spine (Phila Pa 1976) 2024; 49:E164-E172. [PMID: 38420729 DOI: 10.1097/brs.0000000000004975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
STUDY DESIGN Anatomical study. OBJECTIVE This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance. SUMMARY OF BACKGROUND DATA Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP. METHODS An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded. RESULTS The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment. CONCLUSION The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments.
Collapse
Affiliation(s)
- Zexian Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Junjie Chen
- The Spine Department, Orthopaedic Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Duopei Fang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyang Zheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chaohui Fan
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shiwen Luo
- Department of Anatomy, School of the Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
2
|
Karri J, Cohen SP. High-intensity focused ultrasound as the savior for lumbar facet joint neurotomy: fact, fad, or fiction? Reg Anesth Pain Med 2024:rapm-2024-105515. [PMID: 38724269 DOI: 10.1136/rapm-2024-105515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024]
Affiliation(s)
- Jay Karri
- Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven P Cohen
- Professor of Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Professor of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Professor of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Truong K, Meier K, Ahrens LC, Wichmann TO, Zaer H, Tiroke LH, Arvin S, Bazys M, Duel P, Gudmundsdottir G, Carlsen JG, Nikolajsen L, van Tulder M, Sørensen JCH, Rasmussen MM. Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial. RMD Open 2024; 10:e004196. [PMID: 38724261 PMCID: PMC11086270 DOI: 10.1136/rmdopen-2024-004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up. DESIGN Single-centre, single-blinded placebo-controlled randomised controlled trial. SETTING Single-centre study. PARTICIPANTS Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block (>50% pain reduction after 60 min). INTERVENTIONS 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups. MAIN OUTCOME MEASURES Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months. RESULTS There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints. CONCLUSIONS Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up. TRIAL REGISTRATION NUMBER NCT04786145.
Collapse
Affiliation(s)
- Kamilla Truong
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Meier
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Cramer Ahrens
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thea Overgaard Wichmann
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hamed Zaer
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lasse Hubertus Tiroke
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Arvin
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mindaugas Bazys
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Duel
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lone Nikolajsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Anesthesiology, Aarhus University, Aarhus, Denmark
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikkel Mylius Rasmussen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Center for Experimental Neuroscience (CENSE) and CENSE-spine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Ruiz Santiago F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. LA RADIOLOGIA MEDICA 2024; 129:794-806. [PMID: 38512629 DOI: 10.1007/s11547-024-01809-8] [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: 08/14/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. MATERIALS AND METHODS A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). RESULTS Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. CONCLUSIONS RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.
Collapse
Affiliation(s)
- Antonio Jesús Láinez Ramos-Bossini
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain.
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain.
| | - Paula María Jiménez Gutiérrez
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Anesthesiology, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| |
Collapse
|
5
|
Gofeld M, Smith KJ, Bhatia A, Djuric V, Leblang S, Rebhun N, Aginsky R, Miller E, Skoglind B, Hananel A. Fluoroscopy-guided high-intensity focused ultrasound neurotomy of the lumbar zygapophyseal joints: a prospective, open-label study. Reg Anesth Pain Med 2024:rapm-2024-105345. [PMID: 38580339 DOI: 10.1136/rapm-2024-105345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE The objective of this study is to investigate safety and effectiveness of a fluoroscopy-guided high-intensity focused ultrasound (HIFU) system for thermal ablation of the lumbar medial branch nerves. METHODS This dual center prospective cohort study enrolled 30 participants with lumbar zygapophyseal joint syndrome. Each participant previously had a positive response to either a single diagnostic analgesic block or radiofrequency ablation (RFA). The primary effectiveness outcome was individual responder rate, defined as a reduction of two points or more on the pain intensity numerical rating scale without an increase in opioid intake, or a reduction in opioid intake without an increase in pain at 6 months after the intervention. The primary safety outcome was procedure-related or device-related adverse events (AEs). Secondary outcome variables included MRI evidence of tissue ablation, Oswestry Disability Index, 12-Item Short Form Health Survey, Brief Pain Inventory, and Patient Global Impression of Change. RESULTS The individual responder rate was 89.7% at 2 days, 89.7% at 7 days, 72.4% at 14 days, 82.1% at 30 days, 59.3% at 90 days and 82.6% at 180 days. The average Numeric Rating Scale for pain severity decreased from 7.1 at baseline to 3.0 (N=29) after 2 days, 3.0 (N=29) after 7 days, 3.1 (N=29) after 14 days, 3.2 (N=28) after 30 days, 4.3 (N=27) after 90 days, and 3.3 (N=23) after 180 days. All participants tolerated the procedure well with no significant side effects or complications. CONCLUSIONS Fluoroscopy-guided HIFU neurotomy achieved clinical responses comparable with RFA, and there were no significant device-related or procedure-related AEs. TRIAL REGISTRATION NUMBER NCT04129034.
Collapse
Affiliation(s)
| | | | - Anuj Bhatia
- Anesthesia and Pain Management, University of Toronto and University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vladimir Djuric
- McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Suzanne Leblang
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | | | | | | | | | | |
Collapse
|
6
|
Qi LN, Sun Y, Shi YT, Yang JH, Yang YR, Qin XZ. Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. Curr Pain Headache Rep 2024:10.1007/s11916-024-01241-7. [PMID: 38526650 DOI: 10.1007/s11916-024-01241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. RECENT FINDINGS There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.
Collapse
Affiliation(s)
- Ling Na Qi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Ye Sun
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yu Tong Shi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Jing Han Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yi Ran Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Xiang Zheng Qin
- Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
| |
Collapse
|
7
|
Gofeld M, Tiennot T, Miller E, Rebhun N, Mobley S, Leblang S, Aginsky R, Hananel A, Aubry JF. Fluoroscopy-guided high-intensity focused ultrasound ablation of the lumbar medial branch nerves: dose escalation study and comparison with radiofrequency ablation in a porcine model. Reg Anesth Pain Med 2024:rapm-2024-105417. [PMID: 38508592 DOI: 10.1136/rapm-2024-105417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a common method for alleviating chronic back pain by targeting and ablating of facet joint sensory nerves. High-intensity focused ultrasound (HIFU) is an emerging, non-invasive, image-guided technology capable of providing thermal tissue ablation. While HIFU shows promise as a potentially superior option for ablating sensory nerves, its efficacy needs validation and comparison with existing methods. METHODS Nine adult pigs underwent fluoroscopy-guided HIFU ablation of eight lumbar medial branch nerves, with varying acoustic energy levels: 1000 (N=3), 1500 (N=3), or 2000 (N=3) joules (J). An additional three animals underwent standard RFA (two 90 s long lesions at 80°C) of the same eight nerves. Following 2 days of neurobehavioral observation, all 12 animals were sacrificed. The targeted tissue was excised and subjected to macropathology and micropathology, with a primary focus on the medial branch nerves. RESULTS The percentage of ablated nerves with HIFU was 71%, 86%, and 96% for 1000 J, 1500 J, and 2000 J, respectively. In contrast, RFA achieved a 50% ablation rate. No significant adverse events occurred during the procedure or follow-up period. CONCLUSIONS These findings suggest that HIFU may be more effective than RFA in inducing thermal necrosis of the nerve.
Collapse
Affiliation(s)
| | | | | | | | | | - Suzanne Leblang
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | | | | | | |
Collapse
|
8
|
Goree JH, Tobey-Moore LR, Petersen E, White C, Judkins D, Brown GA, Virmani T. Radiofrequency ablation for patients with lumbar spinal arthritis provides quantifiable improvement in gait velocity: a prospective study. Reg Anesth Pain Med 2024:rapm-2023-105244. [PMID: 38388011 DOI: 10.1136/rapm-2023-105244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Johnathan Heck Goree
- Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Leah R Tobey-Moore
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erika Petersen
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cale White
- Department of Physical Medical and Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
9
|
McGill KC, Baal JD, Bucknor MD. Update on musculoskeletal applications of magnetic resonance-guided focused ultrasound. Skeletal Radiol 2024:10.1007/s00256-024-04620-8. [PMID: 38363419 DOI: 10.1007/s00256-024-04620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.
Collapse
Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA.
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
| |
Collapse
|
10
|
Tsai PC, Liu YC, Chang TK, Chen LP, Huang YC, Lian YS, Chien KT. The novel Kambin Torpedo full-endoscopic lumbar interbody fusion technique: a case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:417-428. [PMID: 37389696 DOI: 10.1007/s00586-023-07836-9] [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: 01/18/2023] [Revised: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Full-endoscopic lumbar interbody fusion (FELIF) is a new-generation treatment for spondylolisthesis. However, owing to their unique characteristics, the two main endoscopic fusion trajectories, the trans-Kambin and posterolateral approaches, have important limitations. Herein, we aimed to introduce a new technique called Kambin Torpedo FELIF (KT-FELIF). METHODS The KT-FELIF technique is based on the trans-Kambin approach. It additionally completes ipsilateral total facetectomy and contralateral direct decompression. Thus, this novel technique combines the advantages of the trans-Kambin and posterolateral approaches. RESULTS We reported on the indications and technical steps of KT-FELIF and provided intraoperative and animated videos to clarify the procedure. Short-term follow-up based on 3-month postoperative computed tomography and plain films images taken at least 3 months after surgery showed adequate bony decompression, a large bone graft contact area, and good intervertebral trabecular bone growth without radiolucent lines between the graft, cage, and end plate. The clinical results, such as ipsilateral and contralateral visual analog scale and Oswestry disability index values, gradually improved at 1 and 3 months postoperatively. No complications were observed. CONCLUSIONS KT-FELIF is a promising FELIF technique for achieving bilateral direct decompression through a unilateral approach while accomplishing thorough discectomy and endplate preparation.
Collapse
Affiliation(s)
- Ping-Chi Tsai
- Department of Medical Education, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104217, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan
| | - Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104217, Taiwan.
| |
Collapse
|
11
|
Tan L, Du X, Tang R, Rong L, Zhang L. Preoperative Adjacent Facet Joint Osteoarthritis Is Associated with the Incidence of Adjacent Segment Degeneration and Low Back Pain after Lumbar Interbody Fusion. Asian Spine J 2024; 18:21-31. [PMID: 38379146 PMCID: PMC10910148 DOI: 10.31616/asj.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study. PURPOSE To analyze the association between preoperative adjacent facet joint osteoarthritis (FJOA) and outcomes of lumbar interbody fusion (LIF). OVERVIEW OF LITERATURE Whether preoperative adjacent FJOA is associated with the incidence of radiological adjacent segment degeneration (RASD) and low back pain (LBP) relief after lumbar fusion remains unknown. METHODS The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. RESULTS In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498-0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020-1.939). CONCLUSIONS The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.
Collapse
Affiliation(s)
- Lixian Tan
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Xiaokang Du
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Runmin Tang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou,
China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou,
China
| |
Collapse
|
12
|
Yoon JP, Son HS, Lee J, Byeon GJ. Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review. Anesth Pain Med (Seoul) 2024; 19:12-23. [PMID: 38311351 PMCID: PMC10847004 DOI: 10.17085/apm.23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024] Open
Abstract
"Chronic pain after spinal surgery" (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.
Collapse
Affiliation(s)
- Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hong-Sik Son
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
13
|
Camino-Willhuber G, Vildoza S, Martinez E, Canestrari L, Holc F, Oh M, Bhatia N, Lee YP, Bianchi H, Bendersky M. Intervertebral vacuum phenomenon - prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study. Acta Radiol 2024; 65:56-61. [PMID: 36571150 DOI: 10.1177/02841851221146666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic low back pain secondary to degenerative changes in the spine is a common cause of disability, and disc degeneration is one of the most frequent imaging findings. Intervertebral vacuum phenomenon (IVP) is usually observed in advanced degeneration. Recently, this phenomenon has gained interest due to a relatively new surgical technique called percutaneous discoplasty, aimed at treating low back pain secondary to degenerative disc disease in elderly patients. PURPOSE To analyze the prevalence and related factors of the vacuum phenomenon in adult patients. MATERIAL AND METHODS A retrospective cohort study was performed of patients who underwent abdominal computed tomography (CT) for non-spine-related reasons. Age, body mass index, smoking, and CT-based characteristics as presence of IVP, subchondral sclerosis, and facet joint degeneration at the lumbar spine from L1 to the sacrum were included in order to determine the prevalence of the vacuum phenomenon in this population and establish a relationship between this condition and patient demographics and other signs of spine degeneration, such as sclerosis and facet joint disease. RESULTS A total of 238 patients were included in the study (114 men, 124 women; mean age = 75.6 ± 12.3 years. In total, 91 (38%) patients had at least one level of IVP; 59 (25%) patients exhibited subchondral sclerosis, and 235 (98%) facet joint degeneration. Among risk factors, age, smoking, and subchondral sclerosis were significantly associated with the presence of vacuum. CONCLUSION IVP was present in 38% of participants. Risk factors associated with vacuum were age, smoking, and subchondral sclerosis.
Collapse
Affiliation(s)
- Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Vildoza
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Martinez
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lucia Canestrari
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Holc
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, Orange, CA, USA
| | - Nitin Bhatia
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Yu-Po Lee
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Homero Bianchi
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
14
|
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: 3] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
15
|
Hao D, Yong RJ, Cohen SP, Stojanovic MP. Medial Branch Blocks and Radiofrequency Ablation for Low Back Pain from Facet Joints. N Engl J Med 2023; 389:e53. [PMID: 38118025 DOI: 10.1056/nejmvcm2211108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- David Hao
- From Harvard Medical School (D.H., R.J.Y., M.P.S.), the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital (D.H.), the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital (R.J.Y.), and the Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System (M.P.S.), Boston, and the VA Bedford Healthcare System, Bedford (M.P.S.) - all in Massachusetts; and the Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation, and Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, and the Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda - both in Maryland (S.P.C.)
| | - R Jason Yong
- From Harvard Medical School (D.H., R.J.Y., M.P.S.), the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital (D.H.), the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital (R.J.Y.), and the Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System (M.P.S.), Boston, and the VA Bedford Healthcare System, Bedford (M.P.S.) - all in Massachusetts; and the Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation, and Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, and the Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda - both in Maryland (S.P.C.)
| | - Steven P Cohen
- From Harvard Medical School (D.H., R.J.Y., M.P.S.), the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital (D.H.), the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital (R.J.Y.), and the Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System (M.P.S.), Boston, and the VA Bedford Healthcare System, Bedford (M.P.S.) - all in Massachusetts; and the Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation, and Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, and the Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda - both in Maryland (S.P.C.)
| | - Milan P Stojanovic
- From Harvard Medical School (D.H., R.J.Y., M.P.S.), the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital (D.H.), the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital (R.J.Y.), and the Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System (M.P.S.), Boston, and the VA Bedford Healthcare System, Bedford (M.P.S.) - all in Massachusetts; and the Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation, and Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, and the Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda - both in Maryland (S.P.C.)
| |
Collapse
|
16
|
McCormick ZL, Conger A, Kendall R, Wagner G, Henrie AM, Littell M, Sperry BP, Petersen R, Cooper AN, Teramoto M, Burnham TR. A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for the treatment of lumbar facet syndrome: 12 month outcomes. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1318-1331. [PMID: 37578437 PMCID: PMC10690866 DOI: 10.1093/pm/pnad107] [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: 05/16/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold. OBJECTIVE Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements. DESIGN Prospective randomized comparative trial. METHODS Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models. RESULTS Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48-85), 55% (95% CI 34-74), and 45% (95% CI 26-66) of participants met the NPRS responder definition, compared to 25% (95%CI 9-53), 25% (95% CI 9-53), and 17% (95% CI 5-45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05). CONCLUSIONS C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains. TRIAL REGISTRATION DETAILS ClinicalTrials.gov (NCT03614793); August 3, 2018.
Collapse
Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Richard Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Graham Wagner
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - A Michael Henrie
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Madelaine Littell
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Beau P Sperry
- University of California Los Angeles School of Medicine, Los Angeles, CA 90095, United States
| | - Russel Petersen
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Amanda N Cooper
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| |
Collapse
|
17
|
Pendleton J, Ng A. SPECT/CT Scan: A New Diagnostic Tool in Pain Medicine. Curr Pain Headache Rep 2023; 27:729-735. [PMID: 37837482 DOI: 10.1007/s11916-023-01177-4] [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] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the role of SPECT/CT in identifying facet joint arthropathy and the outcomes of interventions with SPECT/CT as an adjunct. RECENT FINDINGS A positive finding of facet arthropathy on SPECT/CT is associated with a higher likelihood of a unilateral procedure and a significantly more effective intervention compared with those performed on patients with facet arthropathy diagnosed only by clinical and/or radiologic examination. Surgical treatment of SPECT/CT-positive findings appears to have a good effect; however, due to limitations in the available studies, no strong conclusion can be drawn. SPECT/CT has a good correlation identifying pain generators in chronic neck and back pain. SPECT/CT-targeted facet interventions demonstrate a higher success rate, but SPECT/CT is not recommended as a first-line diagnostic tool prior to diagnostic facet interventions. More robust studies are needed to confirm the higher success of surgical treatment for SPECT/CT-positive facet arthropathy.
Collapse
Affiliation(s)
- James Pendleton
- Jefferson Pain Center, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Ng
- Jefferson Pain Center, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
18
|
Acosta Julbe JI, Mandell JC, Ermann J, Isaac Z, Gottreich JR, Zampini JM, DeFilipp M, Andrew MN, Katz JN. Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review. Spine (Phila Pa 1976) 2023; 48:1455-1463. [PMID: 37470372 PMCID: PMC10528906 DOI: 10.1097/brs.0000000000004776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN A scoping review. OBJECTIVE We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs). SUMMARY OF BACKGROUND DATA FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections. MATERIALS AND METHODS We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes. RESULTS Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes. CONCLUSION Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.
Collapse
Affiliation(s)
- José I. Acosta Julbe
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jacob C. Mandell
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joerg Ermann
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Julia R. Gottreich
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jay M. Zampini
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam DeFilipp
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael N. Andrew
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiol 2023; 52:1873-1886. [PMID: 36245007 DOI: 10.1007/s00256-022-04184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/02/2023]
Abstract
Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA.
Collapse
Affiliation(s)
- Nicholas Said
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Timothy J Amrhein
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Nicholas C Nacey N
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Peter G Kranz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| |
Collapse
|
20
|
Balza R, Palmer WE. Symptom-imaging correlation in lumbar spine pain. Skeletal Radiol 2023; 52:1901-1909. [PMID: 36862178 DOI: 10.1007/s00256-023-04305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
Lumbar spine MRI is associated with a high prevalence of morphological abnormalities in both symptomatic and asymptomatic individuals. A difficult challenge, therefore, is distinguishing the relevant findings causing symptoms from incidental findings. The accurate diagnosis of pain generator is important because misdiagnosis can negatively impact patient management and outcome. Spine physicians use clinical symptoms and signs to interpret lumbar spine MRI and make treatment decisions. Symptom-MRI correlation enables the targeted inspection of images for pain generator. Radiologists can also use clinical information to improve diagnostic confidence and the value of dictated reports. Because high-quality clinical information may be difficult to obtain, radiologists often generate lists of lumbar spine abnormalities that are otherwise difficult to rank as pain generators. Based on the literature review, this article attempts to distinguish the MRI abnormalities that may represent incidental findings from the abnormalities that are more commonly associated with lumbar spine-related symptoms.
Collapse
Affiliation(s)
- Rene Balza
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA, 02114, USA.
| | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA, 02114, USA
| |
Collapse
|
21
|
Liu Z, Dai G, Cao Y, Duan C. Analysis of Degenerative and Isthmic Lumbar Spondylolisthesis from the Difference of Pelvic Parameters and the Degree of Degeneration through Imaging Data. J Pers Med 2023; 13:1420. [PMID: 37763187 PMCID: PMC10532549 DOI: 10.3390/jpm13091420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In previous studies, many imaging analyses have been conducted to explore the changes in the intervertebral disc degeneration (DD), facet joint osteoarthritis (FJOA), L4 inclination angle (L4IA), pelvis-related parameters, lumbar lordosis (LL), and paravertebral muscle (PVM) in the occurrence and development of degenerative spinal diseases via measuring the X-ray, CT, and MRI data of clinical patients. However, few studies have quantitatively investigated the pelvic parameters and the degree of spine degeneration in patients with degenerative lumbar spondylolisthesis (DLS) and isthmic lumbar spondylolisthesis (ILS). This study discusses the changes in the imaging parameters of DLS, ILS, and a control group; explores the correlation between different measurement parameters; and discusses their risk factors. METHODS We evaluated 164 patients with single L4-L5 grade 1 level degenerative lumbar spondylolisthesis (DLS group), 161 patients with single L4-L5 grade 1 level isthmic lumbar spondylolisthesis (ILS group), and 164 patients with non-specific back pain (control group). The grades of DD and FJOA as well as the percentage of the fat infiltration area (%FIA) of multifidus muscle (MM) at the L4-L5 level were measured via CT and MRI. Lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), the L4 inclination angle (L4IA), and sacral slope (SS) were measured via X-ray film, and the differences among the DLS group, ILS group, and control group were analyzed. Furthermore, the risk factors related to the incidences of the DLS and ILS groups were discussed. RESULTS First, the pelvis-related parameters of DLS and ILS patients were 51.91 ± 12.23 and 53.28 ± 11.12, respectively, while those of the control group were 40.13 ± 8.72 (p1 < 0.001, p2 < 0.001). Lumbar lordosis (LL) in DLS patients (39.34 ± 8.57) was significantly lower than in the control group (44.40 ± 11.79, p < 0.001). On the contrary, lumbar lordosis (LL) in the ILS group (55.16 ± 12.31) was significantly higher than in the control group (44.40 ± 11.79, p < 0.001). Secondly, the three groups of patients were characterized by significant variations in the L4 inclination angle (L4IA), disc degeneration (DD), facet joint osteoarthritis (FJOA), pelvis-related parameters, and paravertebral muscle (PVM) (p < 0.05). Finally, logistic regression suggests that the L4IA, FJOA, and PT may be risk factors for the occurrence of DLS, and the occurrence of ILS is correlated with the L4IA, FJOA, DD, PT, and LL. CONCLUSIONS Compared with the control group, there are changes in pelvic parameters, the L4IA, LL, DD, FJOA, and PVM in DLS and ILS patients, and the degree is different. The parameters within the same group are related to each other, and DLS and ILS have different risk factors. The mechanical stability of the spine is affected by the parameter and angle changes, which may be of great significance for explaining the cause of spondylolisthesis, evaluating the health of the lumbar spine, and guiding the lifestyles of patients.
Collapse
Affiliation(s)
- Zhide Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Guoyu Dai
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Yong Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| | - Chunyue Duan
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China (G.D.)
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha 410008, China
| |
Collapse
|
22
|
Kojima S, Ikemoto T, Arai YC, Hirasawa A, Deie M, Takahashi N. Associations between Degenerative Lumbar Scoliosis Structures and Pain Distribution in Adults with Chronic Low Back Pain. Healthcare (Basel) 2023; 11:2357. [PMID: 37628552 PMCID: PMC10454018 DOI: 10.3390/healthcare11162357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study aimed to investigate the location and distribution of pain in adults with chronic low back pain (LBP) with degenerative lumbar scoliosis (DLS) according to coronal deformities. METHODS We enrolled 100 adults with chronic LBP and DLS, dividing them into two groups, a right-convex DLS group (n = 50) and a left-convex DLS group (n = 50). Dominant pain location was analyzed by dividing it into three parts-left side, right side, and center-and pain areas were identified using the pain drawing method; then, a heat map was created for each group. An association between pain location and convex side was analyzed as the primary outcome. Additionally, we assessed pain characteristics and radiological parameters, such as the curve structure and degree of degeneration. We used the Mann-Whitney U test or the chi-squared test to compare the clinical characteristics of the two groups, and generalized linear models were utilized to determine which variables were associated with pain severity or pain area. RESULTS The results indicated that there was no significant difference between the two groups in terms of the association between the curve structure, pain severity and location. In multivariate analysis, although we did not find any variables associated with pain severity, we observed that age and a left-convex DLS were negatively correlated with pain area among all participants. The heat map demonstrated that individuals with chronic LBP frequently experienced pain in the central lumbar region, regardless of the coronal curve structure. CONCLUSIONS Our findings suggest that degenerative coronal lumbar deformities may not have a specific pain pattern associated with a curved structure.
Collapse
Affiliation(s)
- Shoji Kojima
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan; (S.K.); (A.H.); (M.D.); (N.T.)
| | - Tatsunori Ikemoto
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan; (S.K.); (A.H.); (M.D.); (N.T.)
| | - Young-Chang Arai
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Atsuhiko Hirasawa
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan; (S.K.); (A.H.); (M.D.); (N.T.)
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan; (S.K.); (A.H.); (M.D.); (N.T.)
- Department of Orthopaedic Surgery, Hiroshima Citizens Hospital, Hiroshima 730-8518, Japan
| | - Nobunori Takahashi
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan; (S.K.); (A.H.); (M.D.); (N.T.)
| |
Collapse
|
23
|
McCormick R, Shah S. Percutaneous Spinal Interventions for Chronic Pain Management. Semin Neurol 2023; 43:419-431. [PMID: 37549691 DOI: 10.1055/s-0043-1771513] [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: 08/09/2023]
Abstract
Chronic neck and back pain are two of the most common and disabling complaints seen in primary care and neurology practices. Most commonly these come in the form of cervical and lumbar radiculopathy, lumbar spinal stenosis, and cervical and lumbar facet arthropathy. Treatment options are widespread and include nonpharmacological, pharmacological, surgical, and interventional options. The focus of this review will be to discuss the most common interventional procedures performed for chronic cervical and lumbar back pain, common indications for performing these interventions, as well as associated benefits and risks. These interventions alone may not suffice to improve the quality of life in those suffering from chronic pain. However, an understanding of the interventional pain options available and the evidence behind performing these interventions can help providers incorporate these into a multimodal approach to provide effective pain management that may allow patients an improved quality of life.
Collapse
Affiliation(s)
- Robert McCormick
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Sunali Shah
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
24
|
van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [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: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
Collapse
Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
25
|
Middendorf JM, Budrow CJ, Ellingson AM, Barocas VH. The Lumbar Facet Capsular Ligament Becomes More Anisotropic and the Fibers Become Stiffer With Intervertebral Disc and Facet Joint Degeneration. J Biomech Eng 2023; 145:051004. [PMID: 36478033 PMCID: PMC9933886 DOI: 10.1115/1.4056432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Degeneration of the lumbar spine, and especially how that degeneration may lead to pain, remains poorly understood. In particular, the mechanics of the facet capsular ligament may contribute to low back pain, but the mechanical changes that occur in this ligament with spinal degeneration are unknown. Additionally, the highly nonlinear, heterogeneous, and anisotropic nature of the facet capsular ligament makes understanding mechanical changes more difficult. Clinically, magnetic resonance imaging (MRI)-based signs of degeneration in the facet joint and the intervertebral disc (IVD) correlate. Therefore, this study examined how the nonlinear, heterogeneous mechanics of the facet capsular ligament change with degeneration of the lumbar spine as characterized using MRI. Cadaveric human spines were imaged via MRI, and the L2-L5 facet joints and IVDs were scored using the Fujiwara and Pfirrmann grading systems. Then, the facet capsular ligament was isolated and biaxially loaded. The nonlinear mechanical properties of the ligament were obtained using a nonlinear generalized anisotropic inverse mechanics analysis (nGAIM). Then a Holzapfel-Gasser-Ogden (HGO) model was fit to the stress-strain data obtained from nGAIM. The facet capsular ligament is stiffer and more anisotropic at larger Pfirrmann grades and higher Fujiwara scores than at lower grades and scores. Analysis of ligament heterogeneity showed all tissues are highly heterogeneous, but no distinct spatial patterns of heterogeneity were found. These results show that degeneration of the lumbar spine including the facet capsular ligament appears to be occurring as a whole joint phenomenon and advance our understanding of lumbar spine degeneration.
Collapse
Affiliation(s)
- Jill M Middendorf
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | | | - Arin M Ellingson
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN 55455
| | - Victor H Barocas
- Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455
| |
Collapse
|
26
|
Kose HC. Exploring the Use of Facet Joint Injections Through Instagram. Cureus 2023; 15:e38554. [PMID: 37292571 PMCID: PMC10245078 DOI: 10.7759/cureus.38554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Facet joint injection (FJI) is a minimally invasive procedure used to relieve pain and inflammation in the facet joints of the spine. In light of the growing presence of social media, it is essential to comprehend its effects on the healthcare industry. Little is known about how FJI is discussed on Instagram. The purpose of this study was to investigate the characteristics and production sources of FJI-related posts on Instagram. METHODS AND MATERIALS This study provides a descriptive analysis of Instagram posts with the keywords #facetjointinjection, #facetjointinjections, #facetinjection, #facetinjections, #facetblock, and #facetblocks on March 1, 2023. The results were categorized by source into four groups; posts created by healthcare professionals (surgeon/non-surgeon), medical organizations, patients, or not otherwise specified. The content was categorized by type (educational and patient/physician experience) and user influence (number of followers and posts). RESULTS The search resulted in 2718 posts. Most post uploaders were mainly physicians (43.1%, n = 275). The distribution of remaining Instagram users with FJIs posts was as follows: 27.1% (n=173) patients, 16.3% (n=104) medical organizations, and 13.4% (n=86) not otherwise specified. Among the posts, 1136 (41.7 %) were from accounts created by patients, 1015 (37.3%) by physicians, 441 (16.2%) by medical organizations, and 126 (4.6%) were unspecified. The analysis showed a significant difference in the distribution of posts among patients and physicians, as well as patients and other unspecified groups (p<0.05). The reported side effects were as follows: pain around the injection site (36%), swelling (17%), weight gain (15%), and anxiety (32%). CONCLUSIONS This study demonstrates that physicians are widely present on social media. However, when searching for posts about facet joint interventions, posts written by patients are more likely to be seen by the public. The results of this article emphasize the impact physicians have on online platforms and the need to raise FJI awareness on Instagram. Due to a lack of information and their anxiety about the unknown, patients have voiced hesitation about undergoing FJIs. To address this issue, it is the responsibility of physicians to enhance the accessibility of accurate information for patients in order to alleviate their anxiety. Additionally, reputable pain medicine societies and qualified specialists should upload credible posts on facet joint interventions that include accurate information, high-quality images and videos, and proper scientific commentary, with the aim of enhancing the quality of online health information.
Collapse
Affiliation(s)
- Halil C Kose
- Pain Medicine, Kocaeli City Hospital, Kocaeli, TUR
| |
Collapse
|
27
|
Bharadwaj UU, Christine M, Li S, Chou D, Pedoia V, Link TM, Chin CT, Majumdar S. Deep learning for automated, interpretable classification of lumbar spinal stenosis and facet arthropathy from axial MRI. Eur Radiol 2023; 33:3435-3443. [PMID: 36920520 PMCID: PMC10566647 DOI: 10.1007/s00330-023-09483-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To evaluate a deep learning model for automated and interpretable classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy from lumbar spine MRI. METHODS T2-weighted axial MRI studies of the lumbar spine acquired between 2008 and 2019 were retrospectively selected (n = 200) and graded for central canal stenosis, neural foraminal stenosis, and facet arthropathy. Studies were partitioned into patient-level train (n = 150), validation (n = 20), and test (n = 30) splits. V-Net models were first trained to segment the dural sac and the intervertebral disk, and localize facet and foramen using geometric rules. Subsequently, Big Transfer (BiT) models were trained for downstream classification tasks. An interpretable model for central canal stenosis was also trained using a decision tree classifier. Evaluation metrics included linearly weighted Cohen's kappa score for multi-grade classification and area under the receiver operator characteristic curve (AUROC) for binarized classification. RESULTS Segmentation of the dural sac and intervertebral disk achieved Dice scores of 0.93 and 0.94. Localization of foramen and facet achieved intersection over union of 0.72 and 0.83. Multi-class grading of central canal stenosis achieved a kappa score of 0.54. The interpretable decision tree classifier had a kappa score of 0.80. Pairwise agreement between readers (R1, R2), (R1, R3), and (R2, R3) was 0.86, 0.80, and 0.74. Binary classification of neural foraminal stenosis and facet arthropathy achieved AUROCs of 0.92 and 0.93. CONCLUSION Deep learning systems can be performant as well as interpretable for automated evaluation of lumbar spine MRI including classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy. KEY POINTS • Interpretable deep-learning systems can be developed for the evaluation of clinical lumbar spine MRI. Multi-grade classification of central canal stenosis with a kappa of 0.80 was comparable to inter-reader agreement scores (0.74, 0.80, 0.86). Binary classification of neural foraminal stenosis and facet arthropathy achieved favorable and accurate AUROCs of 0.92 and 0.93, respectively. • While existing deep-learning systems are opaque, leading to clinical deployment challenges, the proposed system is accurate as well as interpretable, providing valuable information to a radiologist in clinical practice.
Collapse
Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
| | - Miranda Christine
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Steven Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| |
Collapse
|
28
|
Bernardes ALPR, Correa RF, Trajano LADSN, Fontes IA. Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review. Rev Bras Ortop 2023; 58:199-205. [PMID: 37252302 PMCID: PMC10212637 DOI: 10.1055/s-0043-1768695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 05/31/2023] Open
Abstract
Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.
Collapse
|
29
|
Bauones S, Cazzato RL, Dalili D, Koch G, Garnon J, Gantzer J, Kurtz JE, Gangi A. Precision pain management in interventional radiology. Clin Radiol 2023; 78:270-278. [PMID: 36931782 DOI: 10.1016/j.crad.2022.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 03/17/2023]
Abstract
Pain is a common manifestation of several benign and malignant conditions. Inadequate response to conservative therapies is often succeeded by incremental use of analgesics and opioids; however, such an approach is often ineffective, not well tolerated by patients, and carries the risk of addiction leading to the opioid crisis. Implementing minimally invasive percutaneous procedures, performed by interventional radiologists has proven to be successful in providing safe, effective, and patient-specific therapies across a wide range of painful conditions. In the present narrative review, we will review the repertoire of minimally invasive imaging guided interventions, which have been successfully used to treat common painful benign and malignant conditions. We briefly describe each technique, common indications, and expected results.
Collapse
Affiliation(s)
- S Bauones
- Medical Imaging Administration, Musculoskeletal Imaging Department (AlAwaji, Banuones), King Fahad Medical City, Riyadh, Saudi Arabia; Radiology and Medical Imaging Department (Alsaadi), College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz Alkharj, Saudi Arabia
| | - R L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France.
| | - D Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK; Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG, UK
| | - G Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Institut of Human Anatomy, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France; Department of Cancer and Functional Genomics INSERM UMR_S1258, Institute of Genetics and of Molecular and Cellular Biology, 67400, Illkirch, France
| | - J E Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, London, WC2R 2LS, UK
| |
Collapse
|
30
|
Singh C, Yadav S, Loha S, Prakash S, Paswan AK. Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917231161836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Study design: Prospective randomized clinical study. Purpose: To compare the effectiveness and safety of intra-articular platelet-rich plasma (PCP) and steroid along with radiofrequency ablation (RFA) in the treatment of chronic low back pain (LBP) due to facet joint arthropathy. Overview of literature: Facet joint pathology is an important cause of LBP—15–30% of all LBP cases. Lumbar intra-articular PRP is a relatively new method in the treatment of LBP. PRP stimulates the cells involved in regeneration. Hence, it seems a suitable option for the treatment of lumbar facet joint syndrome. Methods: We evaluated the efficacy and safety of facet joint injections in LBP secondary to facet joint arthropathy. Chronic LBP for ≥3 months (visual analogue scale (VAS) > 4), failed conservative treatment, no neurological deficit, unilateral facet joint pain, focal tenderness with hyperextension pain, and relief by diagnostic medial branch block were included. Patients were randomly allocated to Group S: Steroid (Triamcinolone) + RFA or Group P: PRP + RFA or Group R: 0.9% saline + RFA as control. Demographic, clinico-radiological, and outcome parameters were recorded till 6 months. Data were analyzed using SPSS and p < 0.05 was considered significant. Results: We studied 45 patients (n = 15 in each group) in the final analysis. Mean age was 45.7 ± 13.6 years and 60% were females in all groups. VAS decreased to 1.6 ± 0.8 (Group S) and 3.2 ± 0.8 (Group P) on day 1 ( p < 0.05). At 3 and 6 months, VAS reduced more in Group P (0.47 ± 0.5; 0.07 ± 0.2) versus Group S (2.53 ± 0.5; 3.07 ± 0.2) ( p < 0.001). Mean Oswestry Disability Index (ODI) score at baseline was 72.8 ± 7.6 (all groups). At 1 month, Group S (17.2 ± 3.2) showed better improvement than Group P (23.2 ± 3.1) ( p < 0.05). At 6 months, Group P (8.9 ± 1.2) had more decrease in ODI than Group S (29.0 ± 2.1) ( p < 0.001). NSAIDs usage and Patient Satisfaction Score (PSS) were significantly better at 6 months in Group P than Group S ( p < 0.01; p < 0.05, respectively). Conclusion: Both PRP and corticosteroid injections were determined to be effective and safe for the treatment of lumbar facet joint syndrome after 6 months of follow-up. However, autologous PRP may be a superior treatment option for longer efficacy.
Collapse
Affiliation(s)
- Chandan Singh
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sanjay Yadav
- Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sandeep Loha
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shashi Prakash
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anil Kumar Paswan
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
31
|
Nisolle ML, Ghoundiwal D, Engelman E, El Founas W, Gouwy J, Guntz E, Kapessidou P, Tuna T. Comparison of the effectiveness of ultrasound-guided versus fluoroscopy-guided medial lumbar bundle branch block on pain related to lumbar facet joints: a multicenter randomized controlled non-inferiority study. BMC Anesthesiol 2023; 23:76. [PMID: 36906521 PMCID: PMC10007783 DOI: 10.1186/s12871-023-02029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The aim of this multicenter randomized interventional prospective study was to compare the ultrasound (US)-guided lumbar medial branch block (LMBB) with the fluoroscopy (FS)-guided LMBB in terms of analgesic efficacy and disability in the setting of the treatment of pain arising from the lumbar facet joints (LFJ). METHODS Fifty adults with a "LFJ" syndrome were randomized into two groups: in group FS, fluoroscopic-guidance was used to block the medial branch at three lumbar levels (L3-L4, L4-L5 and L5-S1); in group US, same blocks were performed under ultrasound. Needle transverse approach was used with both techniques. Effects of these procedures were assessed with a Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Duke's Activity Status Index (DASI) scale, before the treatment, 1 week and 1 month after. Hospital Anxiety and Depression Scale (HADS) score was also collected before the procedure. Analysis of variance, one (for non-inferiority) and two-sided Mann-Whitney tests and Chi-square tests were performed. RESULTS LMBB under US-guidance was not inferior to FS-guidance (P = 0.047) in terms of VAPS, ODI and DASI at 1 week and 1 month. Duration of techniques and HADS were similar between groups (=0.34; p = 0.59). CONCLUSIONS The medial lumbar bundle branch block under ultrasound-guidance is not inferior to the fluoroscopy-guidance procedure in effectively alleviating pain arising from the facet joints. Considering that this ultrasound technique has the benefit of an irradiation-free, real-time procedure, it can be considered as an effective alternative to the fluoroscopy-guided technique.
Collapse
Affiliation(s)
- Marie-Laure Nisolle
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium.
| | - Djamal Ghoundiwal
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | | | - Walid El Founas
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | - Jonathan Gouwy
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Rue Wayez 35, 1420, Braine-l'Alleud, Belgium
| | - Emmanuel Guntz
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Rue Wayez 35, 1420, Braine-l'Alleud, Belgium
| | - Panayota Kapessidou
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | - Turgay Tuna
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium
| |
Collapse
|
32
|
Wu L, Lin J, Liu Y, Wei Z, Chen C, Zhuang Y. Mixed reality technology enhances teaching of spinal blockade procedures. Clin Anat 2023; 36:687-693. [PMID: 36797443 DOI: 10.1002/ca.24028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
To investigate the efficacy of utilizing mixed reality technology-assisted teaching of a spinal medial branch nerve block. Twenty undergraduate students from a 5-year clinical medicine program in Fujian Medical University were selected. They were divided into group A and group B using a random number generator, with 10 students in each group. Group A used the traditional teaching method and Group B used the mixed reality technology-assisted teaching method. At the end of the teaching period, both groups were assessed on the blocking operation, number of punctures required, puncture time, and final error value (distance between the final position and the reference position). A questionnaire was administered to both groups to assess teaching satisfaction. The number of punctures required was 7.40 ± 1.26 and 2.10 ± 0.74 for groups A and B, respectively. The puncture time in group A was 297.80 ± 50.95 s and 65.60 ± 22.02 s in group B. All differences were significant p < 0.01. The final error of the puncture in group A was 2.24 ± 0.35 mm and 1.96 ± 0.26 mm in group B-not significant. Group B had (p < 0.01) higher evaluation scores than group A for teaching effectiveness, learning interest, initiative, and teaching satisfaction. The application of mixed reality technology in the teaching of posterior medial branch blocks of the spinal nerve is superior to previous methods. This method should be adopted wherever possible to enhance learning of this difficult technique.
Collapse
Affiliation(s)
- Liulei Wu
- Fujian Medical University, Fuzhou, China
| | - Jiehui Lin
- Fujian Medical University, Fuzhou, China
| | - Yaqi Liu
- Fujian Medical University, Fuzhou, China
| | - Zhujun Wei
- Fujian Medical University, Fuzhou, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuandong Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
33
|
Oswald KAC, Ekengele V, Hoppe S, Streitberger K, Harnik M, Albers CE. Radiofrequency Neurotomy Does Not Cause Fatty Degeneration of the Lumbar Paraspinal Musculature in Patients with Chronic Lumbar Pain-A Retrospective 3D-Computer-Assisted MRI Analysis Using iSix Software. PAIN MEDICINE 2023; 24:25-31. [PMID: 35775938 DOI: 10.1093/pm/pnac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The present study aimed (1) to analyze the relative paraspinal autochthonous intramuscular fat volume before and after radiofrequency neurotomy (RFN) and (2) to compare it to the contralateral non-treated side. DESIGN Retrospective cohort study. SETTING Inselspital, University Hospital Bern, University of Bern. SUBJECTS Twenty patients (59.60 ± 8.49 years; 55% female) with chronic low back pain, treated with RFN (L2/3-L5/S1) due to symptomatic facet joint syndrome (FCS) between 2008 and 2017 were included. METHODS All patients received a magnetic resonance imaging (MRI) of the lumbar spine before and at a minimum of 6 months after RFN. The absolute (cm3) and relative (%) paraspinal muscle and fat volume was analyzed three-dimensionally on standard T2-MRI sequences using a newly developed software (iSix, Osiris plugin). Both sides were examined and allocated as treated or non-treated side. RESULTS A total of 31 treated and 9 non-treated sides (Level L2/3-L5/S1) were examined. There were no differences in the relative paraspinal intramuscular fat volume before and at a median of 1.4 [0.9 - 2.6] years after RFN (P = .726). We found no differences in the relative fat volume between the treated and non-treated side before (P = .481) and after (P = .578) RFN. CONCLUSIONS Our study shows that there are no differences in the paraspinal muscle/fat distribution after RFN. RFN of the medial branches for FCS does not seem to cause fatty degeneration of the lumbar paraspinal muscles as a sign of iatrogenic muscle denervation.
Collapse
Affiliation(s)
- Katharina A C Oswald
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Venant Ekengele
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Hoppe
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Spine Medicine Bern, Hirslanden Salem-Spital, Bern, Switzerland
| | - Konrad Streitberger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
34
|
Lo Bianco G, Misseri G, Stogicza AR, Cesare G, Li S, Day M, Kennedy DJ, Schatman ME. Radiofrequency Ablation for Chronic Lumbar Zygapophyseal Joint Pain Using a V-Shaped Active Tip Needle: An Observational Retrospective Study. J Pain Res 2023; 16:1243-1255. [PMID: 37069943 PMCID: PMC10105587 DOI: 10.2147/jpr.s406714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
Background Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles. Methods This is a single-center observational retrospective study. Clinical records were screened and analyzed if they met the following inclusion criteria: adult patients (>18 years), diagnosis of chronic lumbar zygapophyseal joint pain, failure of conservative treatments, ability to provide informed consent for data analysis and publication. Exclusion criteria: lumbar pain not related to zygapophyseal joints, previous spinal/lumbar surgery, incomplete data, absence or withdrawal of informed consent. The primary outcome of the study was a change in pain intensity at follow-up. The secondary outcomes were the evaluation of quality-of-life improvement, the occurrence of adverse events and the impact on post-procedural analgesic consumption. For these purposes, pre- and post-treatment numeric rating scale (NRS), neuropathic pain 4 questions (DN4), EuroQoL - EQ-5D-3L, EQ-VAS, EQ-index and North American Spine Society (NASS) index were retrieved and analysed. Results Sixty-four patients were included. 7.8% of patients at 1-month (CI95% 0.026, 0.173), 37.5% at 3-month (CI95% 0.257, 0.505), 40.6% at 6-month (CI95% 0.285, 0.536) and 35.9% at 9-month (CI95% 0.243, 0.489) follow-up reported a reduction of more than 80% in NRS Statistical analysis indicated a significant change in NRS, DN4, EQ-index and EQ-5D-VAS (p-value <0.001) at the different time-points. Conclusion RFA using a V-shaped active tip needle might be a feasible and effective treatment for chronic lumbar zygapophyseal joint pain.
Collapse
Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
- Correspondence: Giuliano Lo Bianco, Anesthesia and Pain Medicine Department, Fondazione Giglio Cefalù, Contrada Pietrapollastra, Via Pisciotto, Cefalù, Palermo, 90015, Italy, Tel +393289682219, Email
| | - Giovanni Misseri
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
| | - Agnes R Stogicza
- Anesthesia and Pain, Saint Magdolna Private Hospital, Budapest, Hungary
| | - Gregoretti Cesare
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Sean Li
- National Spine and Pain Centers, Shrewsbury, NJ, USA
| | - Miles Day
- Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA
| | - David J Kennedy
- Department of PM&R, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
35
|
Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
Collapse
Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| |
Collapse
|
36
|
Kim YS, Kim T, Lee Y, Oh YJ, Oh J, Doo AR. Medial Branch Radiofrequency Treatment for Low-Back Pain in Cancer Patients: A Case Series. Palliat Med Rep 2022; 3:316-321. [PMID: 36479548 PMCID: PMC9712039 DOI: 10.1089/pmr.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cancer patients are increasing in number, with an increased lifespan and advances in cancer treatment. Palliative care physicians often encounter difficulties in caring for patients with pain. In addition to cancer-related pain, patients with cancer may suffer from various musculoskeletal diseases, resulting in significant functional limitations of physical activities of daily living. We present three cases illustrating methods to deal with nonspecific mechanical low-back pain in patients with advanced cancer. We provide our therapeutic experiences, focusing on the usefulness of radiofrequency treatment in palliative care in patients with cancer.
Collapse
Affiliation(s)
- Ye Sull Kim
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Taehoon Kim
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Youngkwan Lee
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Yu Jin Oh
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Jeongmin Oh
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea.,Address correspondence to: A Ram Doo, MD, PhD, Department of Anesthesiology and Pain Medicine, Medical School, Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeollabuk-do 54907, South Korea.
| |
Collapse
|
37
|
Local Infiltrations in Patients with Radiculopathy or Chronic Low Back Pain Due to Segment Degeneration-Only A Diagnostic Value? J Pers Med 2022; 12:jpm12111791. [PMID: 36579536 PMCID: PMC9692610 DOI: 10.3390/jpm12111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to investigate the differences in the therapeutic effectiveness of CT-assisted infiltration of a local anesthetic + corticosteroid between nerve root and facet joint capsule in patients with chronic complaints. In this prospective trial with a 12-month follow-up, a total of 250 patients with chronic low back pain and radiculopathy were assigned to two groups. In the first group, patients with specific lumbar pain due to spondyloarthritis received periarticular facet joint capsule infiltration (FJI). In the second group, patients with monoradicular pain received periradicular infiltration (PRI) via an extraforaminal selective nerve block. Clinical improvement after FJI and PRI regarding pain (NRS), function (ODI), satisfaction (McNab), and health related quality of life (SF-36) were compared. Minimally clinically important difference (MCID) served as the threshold for therapeutic effectiveness evaluation. A total of 196 patients were available for final analysis. With respect to the pain reduction and functional improvement (ODI, NRSoverall, and NRSback), the PRI group performed significantly better (ptreatment < 0.001) and longer over time (ptreatment × time 0.001) than the FJI group. Regarding pain and function, only PRI demonstrated a durable improvement larger than MCID. A significant and durable therapeutic value was found only after receiving PRI but not after FJI in patients with chronic pain.
Collapse
|
38
|
Zhang Z, Liu J, Xu Y, Chen Z, Luo S, Zhang X, Wang G, Cheng L. Anatomical study and clinical significance of the posterior ramus of the spinal nerve of the lumbar spine. Front Cell Dev Biol 2022; 10:1019309. [PMID: 36263013 PMCID: PMC9573941 DOI: 10.3389/fcell.2022.1019309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background and objectives: Chronic nonspecific back pain is a common clinical disease typically treated by ultrasound-guided spinal injection. This minimally invasive treatment targets the posterior ramus of the spinal nerve (PRSN). The target of the medial branch is clear, but there is unclear target for the intermediate and lateral branches. This study attempted to observe the distribution of PRSN in the dorsal region of transverse process to provide a more detailed anatomical basis for treating spinal pain. Methods: The present study was conducted on 16 transverse processes of six adult male embalmed corpses. The dorsal area of the transverse process was divided into three equal zones, which are zone I, zone II and zone III from inside to outside. The origin, distribution, quantity, transverse diameter, and relationship with the bone structure of the PRSN on the transverse process were observed. Results: Sixty PRSNs were found in the lumbar of six cadavers, of which 48 were divided into three branches, and 12 PRSNs were divided into two branches. The intermediate branch is mainly distributed in zone I, and the lateral branch is mainly distributed in zone II. Twenty-nine communicating branches were found in 48 adjacent segments of six specimens, all of which originated from the intermediate branch of the previous segment and connected with the lateral branch of the next segment. Conclusion: This anatomical study describing the PRSN may have important clinical significance for spinal surgeons. Understanding the bony localization targets of the PRSN and the links between the PRSNs may benefit patients with low back pain who receive spinal injections.
Collapse
Affiliation(s)
- Zhenfeng Zhang
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liu
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zeyan Chen
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
| | - Shiwen Luo
- Department of Anatomy, School of the Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Orthopaedics and Traumatology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Guoliang Wang
- Department of Orthopedics, Guangzhou Development District Hospital, Guangzhou, China
- *Correspondence: Guoliang Wang, ; Liang Cheng,
| | - Liang Cheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Guoliang Wang, ; Liang Cheng,
| |
Collapse
|
39
|
Le VT, Do PT, Nguyen AM, Nguyen Dao LT. Thermal Radiofrequency Ablation Combined with Corticosteroid Injection in Management of Lumbar Facet Joint Pain: A Single-Center Study in Vietnam. World Neurosurg 2022; 166:237-243.e1. [PMID: 35953043 DOI: 10.1016/j.wneu.2022.07.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to evaluate the effectiveness of thermal radiofrequency ablation combined with corticosteroid injection for medial branch block in the management of chronic low back pain, which originates from lumbar facet joint (LFJ) pain. METHODS A prospective observational study of 82 patients with chronic LFJ pain undergoing thermal radiofrequency ablation combined with corticosteroid injection was conducted. Primary outcomes included pain relief and functional recovery, measured by the visual analog scale (VAS) and Oswestry Disability Index, respectively. Secondary outcome was the time of recurrent low back pain at the same spinal segment after treatment. Adverse events were also recorded. RESULTS Mean age is 55.7 ± 15.2 years old, and duration of LFJ pain was 18.2 ± 9.5 months. Median VAS at baseline was 7.0 (7.0-9.0) for all ages. After intervention, VAS and Oswestry Disability Index improved significantly (P < 0.001). Pain relief lasted for 1 month, 3 months, 6 months, 12 months, and 12-24 months' follow-up. During this period, only 5 patients required another radiofrequency neurotomy procedure (6.1%). No complications occurred in the study group. CONCLUSIONS Thermal radiofrequency ablation combined with corticosteroid injection should be a potential method of choice for its effectiveness, long-lasting effect, and safety in the management of LFJ pain.
Collapse
Affiliation(s)
- Viet-Thang Le
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam; Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phuoc Trong Do
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Anh Minh Nguyen
- Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Vietnam; Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | |
Collapse
|
40
|
Akgun E, Akgun MY. The effectiveness of bone scintigraphy in the management of low back pain. Clin Neurol Neurosurg 2022; 222:107440. [PMID: 36166994 DOI: 10.1016/j.clineuro.2022.107440] [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: 08/08/2022] [Revised: 09/04/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Back and low back pain have been reported as one of the leading causes of activity restriction. While degenerative changes in the spine are among the common causes of low back pain, zygapophyseal (facet) joint pain is seen as the most widely accepted cause of back pain. Standard imaging modalities may have low predictive value in detecting the source of back pain. Thanks to radionuclide bone scintigraphy, painful lesions can be distinguished from age-related changes, especially in patients with chronic low back pain. In this study, we aimed to retrospectively evaluate the clinical results of facet-induced low back pain, which was confirmed by bone scintigraphy, after facet injection treatment. METHODS We completed a retrospective review of patients who underwent diagnostic radionuclide bone scintigraphy imaging for low back pain at our institution from 2019 to 2021. Scintigraphy imaging was often performed in conjunction with traditional diagnostic imaging. The patients underwent injection at the levels that were decided by the referring physician on the basis of the clinical symptoms, the physical examination findings, and findings on existing radiologic images, with performance of bone scanning. RESULTS The patients consisted of 24 (47.1 %) males and 27 (52.9 %) females with a mean age of 44.03 ± 9.26 years (range 34-67 years) at initial symptom onset. In the bone scintigraphy, increased radioactive uptake was detected in the facet joints of the lumbar region in 33 of 51 (64.7 %) patients. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 30 patients (90.1 %) after injection in patients with increased radioactive uptake. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 12 (66.6 %) patients who had no pathological findings with imaging modalities and were injected according to physical examination. When the two groups were compared with each other, the success rate in the group with increased radioactive uptake was found to be statistically significantly higher (p < 0.01) CONCLUSIONS: Application of this technology may lead to more reliable diagnosis and treatment of painful facet arthropathy. Appropriate diagnostic tests and determination of spinal level localization will provide satisfactory results with correct patient selection.
Collapse
Affiliation(s)
- Elife Akgun
- Department of Nuclear Medicine, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | | |
Collapse
|
41
|
Wang A, Wang T, Zang L, Yuan S, Fan N, Du P, Wu Q. Quantitative Radiological Characteristics of the Facet Joints in Patients with Lumbar Foraminal Stenosis. J Pain Res 2022; 15:2363-2371. [PMID: 36003291 PMCID: PMC9393112 DOI: 10.2147/jpr.s374720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the degeneration patterns of the facet joints (FJs) in patients with lumbar foraminal stenosis (LFS) and investigate the correlation between quantitative parameters and FJ osteoarthritis (FJ OA). Patients and Methods A total of 171 patients with LFS at the L4/5 level and 146 control patients were enrolled in this study. The severity of FJ OA was graded according to the Weishaupt classification. The FJ orientation, FJ tropism, superior articular process cross-sectional area (SAPA), and FJ area were measured at the L3/4, L4/5, and L5/S1 spinal levels. Associations among the parameters were assessed using Pearson's correlation coefficients. Independent sample t-tests and Pearson's chi-square tests were used for univariate analyses. The association between LFS and the quantitative parameters was also analyzed using multivariate logistic regression models adjusted for age, gender, and body mass index. Results Patients with LFS had more sagittal FJ orientation (37.9 vs 45.0, p < 0.001), more FJ tropism (5.6 vs 3.8, p < 0.001), larger SAPA (129.0 vs 97.8, p < 0.001), and less FJ area (21.7 vs 23.3, p = 0.016). Logistic regression analysis showed that LFS was significantly associated with FJ tropism (odds ratio [OR]: 1.153; p = 0.003) and SAPA (OR: 1.113; p < 0.001). The SAPA showed the largest area under the curve (0.908, 95% confidence interval: 0.875-0.942) for the diagnosis of LFS. The optimal cutoff value was 114.75 mm2 with 85.4% sensitivity and 87.0% specificity. Additionally, a significant correlation was observed between FJ OA and SAPA and FJ area at each studied spinal level. Conclusion This study confirmed that LFS is significantly associated with FJ hypertrophy and tropism. FJ hypertrophy and joint space narrowing correlated with the severity of FJ OA. These results are helpful in understanding the morphology and pathology of FJs.
Collapse
Affiliation(s)
- Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
42
|
Xie H, Ouyang Z, Zhang H. Radiographic Analysis of Pedicle Screw Retractor-Assisted Transforaminal Lumbar Interbody Fusion for Single-Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note. Orthop Surg 2022; 14:2219-2229. [PMID: 35979946 PMCID: PMC9483061 DOI: 10.1111/os.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives The objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction‐reduction and nerve root protection, and to analyze the efficacy and safety of retractor‐assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods This was a retrospective study of 125 patients who underwent retractor‐assisted TLIF for single‐segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t‐test and χ2 test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t‐test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS). Results Unilateral screw retractor‐assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 ± 3.58 mm vs 15.69 ± 3.68 mm, p = 0.599; post: 18.65 ± 2.31 mm vs 18.74 ± 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 ± 5.62% vs 25.18 ± 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 ± 3.12% vs 7.16 ± 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (β: −0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874–0.934, p < 0.001), while the cut‐off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19. Conclusions Pedicle screw retractor‐assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.
Collapse
Affiliation(s)
- Hongwei Xie
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
| | - Ziyu Ouyang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
| | - Hua Zhang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, PR China
| |
Collapse
|
43
|
Malik KM, Nelson AM, Chiang TH, Imani F, Khademi SH. The Specifics of Non-specific Low Back Pain: Re-evaluating the Current Paradigm to Improve Patient Outcomes. Anesth Pain Med 2022; 12:e131499. [PMID: 36937089 PMCID: PMC10016128 DOI: 10.5812/aapm-131499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Low back pain (LBP) is the leading cause of pain and debility worldwide and the most frequent reason for work-related disability. Global expenditures related to LBP are staggering and amount to billions of dollars each year in the United States alone. Yet, despite the considerable healthcare resources consumed, the care provided to patients with LBP has regularly been cited as both ineffective and exorbitant. Among the myriad reasons for this suboptimal care, the current approach to evaluation and management of patients with LBP is a likely contributor and is hitherto un-investigated. Following the current methodology, over 90% of patients with LBP are provided with no specific diagnosis, are managed inconsistently, and receive no express preventative care. We believed that this approach added costs and promoted chronic unresolved pain and disability. This narrative review highlights problems with the current methodology, proposes a novel concept for categorizing patients with LBP, and recommends strategies for improvement. Stratifying patients according to the etiology, in lieu of the prospects for morbidity, the strategy proposed in this article may help ascertain the cause of patient's LBP early, consolidate treatments, permit timely preventative measures, and, as a result, may improve patient outcomes.
Collapse
Affiliation(s)
- Khalid M Malik
- Division of Pain Medicine, Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, USA
- Corresponding Author: Division of Pain Medicine, Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, USA.
| | - Ariana M. Nelson
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, California, USA
| | - Ting-Hsuan Chiang
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, California, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Khademi
- Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding Author: Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
44
|
Lacroix M, Nguyen C, Burns R, Laporte A, Rannou F, Feydy A. Degenerative Lumbar Spine Disease: Imaging and Biomechanics. Semin Musculoskelet Radiol 2022; 26:424-438. [PMID: 36103885 DOI: 10.1055/s-0042-1748912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic low back pain (CLBP) is one of the most common diagnoses encountered when considering years lived with disability. The degenerative changes of the lumbar spine include a wide spectrum of morphological modifications visible on imaging, some of them often asymptomatic or not consistent with symptoms. Phenotyping by considering both clinical and imaging biomarkers can improve the management of CLBP. Depending on the clinical presentation, imaging helps determine the most likely anatomical nociceptive source, thereby enhancing the therapeutic approach by targeting a specific lesion. Three pathologic conditions with an approach based on our experience can be described: (1) pure painful syndromes related to single nociceptive sources (e.g., disk pain, active disk pain, and facet joint osteoarthritis pain), (2) multifactorial painful syndromes, representing a combination of several nociceptive sources (such as lumbar spinal stenosis pain, foraminal stenosis pain, and instability pain), and (3) nonspecific CLBP, often explained by postural (muscular) syndromes.
Collapse
Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Robert Burns
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| | - François Rannou
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université de Paris, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, Université de Paris, Paris, France
| |
Collapse
|
45
|
Lou K, Feng S, Zhang G, Zou J, Zou X. Prevention and Treatment of Side Effects of Immunotherapy for Bladder Cancer. Front Oncol 2022; 12:879391. [PMID: 35669417 PMCID: PMC9164628 DOI: 10.3389/fonc.2022.879391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/19/2022] [Indexed: 12/12/2022] Open
Abstract
Bladder cancer (BC) is one of the most important tumors of the genitourinary system, associated with high morbidity and mortality rates. Over the years, various antitumor treatments have been developed, and immunotherapy is one of the most effective methods. Immunotherapy aims to activate the body’s immune system to kill cancer cells. It has been established that immunotherapy drugs can be classified into “non-targeted” and “targeted” drugs depending on their site of action. Immunotherapy is reportedly effective for BC. Even though it can attack cancer cells, it can also cause the immune system to attack healthy cells, which can occur at any time during treatment and sometimes even after immunotherapy is stopped. Importantly, different types of immunotherapies can cause different side effects. Side effects may manifest themselves as signs or as symptoms. The prevention and treatment of side effects caused by immunotherapy is an important part of cancer patient management.
Collapse
Affiliation(s)
- Kecheng Lou
- The First Clinical College, Gannan Medical University, Ganzhou, China.,Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shangzhi Feng
- The First Clinical College, Gannan Medical University, Ganzhou, China.,Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Guoxi Zhang
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Jiangxi Engineering Technology Research Center of Calculi Prevention, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Junrong Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Jiangxi Engineering Technology Research Center of Calculi Prevention, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xiaofeng Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Jiangxi Engineering Technology Research Center of Calculi Prevention, Gannan Medical University, Ganzhou, Jiangxi, China
| |
Collapse
|
46
|
Oikawa R, Murakami H, Endo H, Yan H, Yamabe D, Chiba Y, Oikawa R, Nishida N, Chen X, Sakai T, Doita M. Comparison of the susceptibility to implant failure in the lateral, posterior, and transforaminal lumbar interbody fusion: A finite element analysis. World Neurosurg 2022; 164:e835-e843. [PMID: 35605942 DOI: 10.1016/j.wneu.2022.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There are several techniques for lumbar interbody fusion, and implant failure following lumbar interbody fusion can be troublesome. This study aimed to compare the stress in posterior implant and peri-screw vertebral bodies among lateral lumbar interbody fusion (LLIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) and to select the technique that is least likely to cause implant failure. METHODS We created an intact L3-L5 model and simulated the LLIF, PLIF, and TLIF techniques at L4-L5 using finite element methods. All models at the lower portion of L5 were fixed and imposed a preload of 400 N and a moment of 7.5 Nm on the upper portion of L3 to simulate flexion, extension, lateral bending, and axial rotation. We investigated the peak stresses and stress concentration in the posterior implant and peri-screw vertebral bodies for the LLIF, PLIF, and TLIF techniques. RESULTS The extension, flexion, bending, and rotation peak stresses and stress concentration in the posterior implant, and the peri-screw vertebral bodies, were the lowest in LLIF, followed by PLIF and TLIF, respectively. CONCLUSIONS It was found that implant failure was least likely to occur in LLIF, followed by PLIF and TLIF, respectively. Hence, surgeons should be aware of these factors when selecting an appropriate surgical technique and be careful for implant failure during postoperative follow-up.
Collapse
Affiliation(s)
- Ryo Oikawa
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan.
| | - Hirooki Endo
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Hirotaka Yan
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Daisuke Yamabe
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Yusuke Chiba
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Ryosuke Oikawa
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan
| | - Xian Chen
- Faculty of Engineering, Yamaguchi University, Ube City, Yamaguchi Prefecture, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan
| | - Minoru Doita
- Department of Orthopedic Surgery, Iwate Medical University, Yahaba Town, Iwate Prefecture, Japan
| |
Collapse
|
47
|
Yan Y, Li J, Yu J, Wang Y, Dong H, Sun Y, Wu X, He L, Chen W, Feng H. Biomechanical evaluation of two fusion techniques based on finite element analysis: percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
48
|
Gill B, Cheney C, Clements N, Przybsyz AG, McCormick ZL, Conger A. Radiofrequency Ablation for Zygapophyseal Joint Pain. Phys Med Rehabil Clin N Am 2022; 33:233-249. [DOI: 10.1016/j.pmr.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
49
|
Abd-Elsayed A, Azeem N, Chopra P, D’Souza RS, Sayed D, Deer T. An International Survey on the Practice of Lumbar Radiofrequency Ablation for Management of Zygapophyseal (Facet)-Mediated Low Back Pain. J Pain Res 2022; 15:1083-1090. [PMID: 35444461 PMCID: PMC9015042 DOI: 10.2147/jpr.s354506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The objective of this study was to survey current clinical practice related to lumbar radiofrequency (RFA) for the treatment of zygapophyseal (facet)-mediated low back pain. Methods Survey questions regarding the clinical practice of lumbar RFA were created and piloted by the American Society of Pain and Neuroscience (ASPN) leadership. After revision for clarity, health-care professionals worldwide who hold membership status within the ASPN Society and who offer lumbar RFA in their clinical practice were recruited to participate in this online survey. All responses were tabulated and summarized descriptively. Results A total of 329 participants responded in the survey. Most participants specialized in anesthesiology (68.4%) and physical medicine and rehabilitation (21.8%) and had been practicing pain management for more than five years (70.5%). Of physician respondents, 27.5% did not complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited pain medicine fellowship and 16.5% were not board-certified in pain medicine. The majority of providers (69.7%) reported that they perform two diagnostic medial branch blocks prior to proceeding with lumbar RFA. Bupivacaine 0.5% was the most common medication utilized for both the first (37.4%) and second (37.1%) diagnostic blocks. There were 32.6% of total respondents who reported not utilizing contrast dye when performing diagnostic blocks. The vast majority of providers (91.4%) reported using conventional RFA for lumbar medial branch neurotomy. Conclusion This survey study provides a summary of the application of lumbar RFA for the treatment of axial low back pain in the real-world setting. We highlight a significant portion of providers who perform lumbar RFA yet do not have pain fellowship training at an ACGME-accredited institution or do not maintain current pain medicine board certification. We also report deviations from standard practice, specifically the type of local anesthetic used for comparative diagnostic blocks and the omission of contrast injection during diagnostic blocks.
Collapse
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, Department of Anesthesiology University of Wisconsin Madison, WI, USA, Email
| | - Nomen Azeem
- Florida Spine & Pain Specialists, Tampa, FL, USA
| | | | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Dawood Sayed
- Department of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- The Spine and Nerve Centers, Charleston, WV, USA
| |
Collapse
|
50
|
Lumbar zygapophyseal joints injections under ultrasound guidance an alternative to fluoroscopy guidance in the management of low back pain. Sci Rep 2022; 12:3615. [PMID: 35256701 PMCID: PMC8901759 DOI: 10.1038/s41598-022-07695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/21/2022] [Indexed: 01/15/2023] Open
Abstract
AbstractUltrasound-guided injections are an alternative to evaluate in the management of low back pain associated with osteoarthritis of the lumbar facet joints: it eliminates the risk of ionizing radiation for both the patient and the practitioner. This study aims to compare the short-term clinical efficacy of lumbar facet joints injections between ultrasound-guided injections and fluoroscopy-guided injections. Observational, retrospective, single-center study. Patients received one or two lumbar zygapophyseal joints injections under fluoroscopy or ultrasound and a follow-up consultation at one month. Data from 54 patients was collected. The median of the evolution of VAS at one month was − 30 mm [−50.0; −20.0] in the ultrasound group and – 29.5 mm [−47.0; −15.0] (p < 0.001) in the fluoroscopy group with no statistically significant difference between the two groups (p = 0.835). There were no injection-related complications in either group during the follow-up. The percentage of patients who stopped NSAIDs was not statistically significant between the two groups (p = 1.00). Injections of corticosteroids of lumbar facet joints under ultrasound guidance significantly reduced pain after one month, with no difference found between the two techniques. Ultrasound-guided injections are reliable, accessible and a safe alternative that should be preferred over those under fluoroscopy.
Collapse
|