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Taninokuchi Tomassoni M, Braccischi L, Russo M, Adduci F, Calautti D, Girolami M, Vita F, Ruffilli A, Manzetti M, Ponti F, Matcuk GR, Mosconi C, Cirillo L, Miceli M, Spinnato P. Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities. Diagnostics (Basel) 2024; 14:1147. [PMID: 38893672 PMCID: PMC11171713 DOI: 10.3390/diagnostics14111147] [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: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients' quality of life, and reducing the economic burden.
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Affiliation(s)
- Makoto Taninokuchi Tomassoni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Lorenzo Braccischi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Mattia Russo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Adduci
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Davide Calautti
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Girolami
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Cristina Mosconi
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Luigi Cirillo
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Macedo F, Annaswamy T, Coller R, Buelt A, Glotfelter MA, Heideman PW, Kang D, Konitzer L, Okamoto C, Olson J, Pangarkar S, Sall J, Spacek LC, Steil E, Vogsland R, Sandbrink F. Diagnosis and Treatment of Low Back Pain: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. Am J Phys Med Rehabil 2024; 103:350-355. [PMID: 37903622 DOI: 10.1097/phm.0000000000002356] [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: 11/01/2023]
Abstract
ABSTRACT Low back pain is a significant issue in the US Department of Veterans Affairs and Department of Defense populations as well as the general US population at large. This type of pain can be distressing to those who experience its effects, leading patients to seek relief of their symptoms. In 2022, leadership within the US Department of Veterans Affairs and US Department of Defense approved a joint clinical practice guideline for the management of low back pain. The guideline provides evidence-based recommendations for assessing and managing low back pain. Development of the guideline included a systematic evidence review, which was guided by 12 key questions. A multidisciplinary team, which included clinical stakeholders, reviewed the evidence that was retrieved and developed 39 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. The scope of the clinical practice guideline is broad; however, the authors have focused on key recommendations that are important for clinicians in the evaluation and nonoperative treatment of low back pain, including pharmacologic therapies and both noninvasive and invasive nonpharmacologic treatments.
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Affiliation(s)
- Franz Macedo
- From the Comprehensive Pain Center, VA Health Care System, Minneapolis, Minnesota (FM); PM&R Service, VA North Texas Health Care System, Dallas, Texas (TA); Naval Medical Center (NMCSD), San Diego, California (RC); VA Medical Center, Bay Pines, Florida (AB); Eielson Medical Treatment Facility, Fairbanks, Alaska (MAG); Comprehensive Pain Center, VA Medical Center, Minneapolis, Minnesota (PWH); Orthopedic Surgery Residency, Madigan Army Medical Center, Tacoma, Washington (DK); Department of Rehabilitation Medicine, Madigan Army Medical Center, Tacoma, Washington (LK); Chiropractic Care, VA Healthcare System (HCS), Minneapolis, Minnesota (CO); Acupuncture, Chinese Medicine, and Chiropractic Care, Pain Clinic, VA Central Iowa HCS, Des Moines, Iowa (JO); David Geffen School of Medicine at UCLA, Los Angeles, California (SP); Veterans Administration Central Office, Washington, District of Colombia (JS); Internal Medicine and Sports Medicine, South Texas Veterans HCS, San Antonio, Texas (LCS); Defense Health Agency, Healthcare Risk Management, Regional Health Command Europe, Primary Care Service Line, Sembach, Germany (ES); Comprehensive Pain Center, VA Health Care System, Minneapolis, Minnesota (RV); and Department of Neurology, VA Medical Center, Washington, District of Colombia (FS)
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3
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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.
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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
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Ambrosio L, Vadalà G, Russo F, Pascarella G, De Salvatore S, Papalia GF, Ruggiero A, Di Folco M, Carassiti M, Papalia R, Denaro V. Interventional Minimally Invasive Treatments for Chronic Low Back Pain Caused by Lumbar Facet Joint Syndrome: A Systematic Review. Global Spine J 2022; 13:1163-1179. [PMID: 36458366 DOI: 10.1177/21925682221142264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To investigate the efficacy of nonsurgical interventional treatments for chronic low back pain (LBP) caused by facet joint syndrome (FJS). METHODS A systematic review of the literature was conducted to identify studies that compared interventional treatments for LBP due to FJS among them, with usual care or sham procedures. Studies were evaluated for pain, physical function, disability, quality of life and employment status. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. RESULTS Eighteen studies published between January 2000 and December 2021 were included (1496 patients, mean age: 54.31 years old). Intraarticular (IA) facet joint (FJ) injection of hyaluronic acid (HA) did not show significant difference compared to IA corticosteroids (CCS) in terms of pain and satisfaction. FJ denervation using radiofrequency (RF) displayed slightly superior or similar outcomes compared to IA CCS, physical therapy, or sham procedure. IA CCS showed better outcomes when combined with oral diclofenac compared to IA CCS or oral diclofenac alone but was not superior to IA local anesthetic and Sarapin. IA platelet-rich plasma (PRP) led to an improvement of pain, disability and satisfaction in the long term compared to IA CCS. CONCLUSION FJS is a common cause of LBP that can be managed with several different strategies, including nonsurgical minimally invasive approaches such as IA HA, CCS, PRP and FJ denervation. However, available evidence showed mixed results, with overall little short-term or no benefits on pain, disability, and other investigated outcomes.
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Affiliation(s)
- Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe F Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Ruggiero
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Marta Di Folco
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
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5
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Du R, Xu G, Bai X, Li Z. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. J Pain Res 2022; 15:3689-3710. [PMID: 36474960 PMCID: PMC9719706 DOI: 10.2147/jpr.s389602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/16/2023] Open
Abstract
Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Gang Xu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
| | - Xujue Bai
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
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6
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Fu JL, Perloff MD. Pharmacotherapy for Spine-Related Pain in Older Adults. Drugs Aging 2022; 39:523-550. [PMID: 35754070 DOI: 10.1007/s40266-022-00946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
As the population ages, spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and renal function, comorbid medical problems, and polypharmacy. This review will assess the evidence basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. A PubMed/OVID search crossing common spine, neck, and back pain terms with key words for older adults and geriatrics was combined with common drug classes and common drug names and limited to clinical trials and age over 65 years. The results were then reviewed with identification of commonly used drugs and drug categories: nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, corticosteroids, gabapentin and pregabalin, antispastic and antispasmodic muscle relaxants, tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tramadol, and opioids. Collectively, 138 double-blind, placebo-controlled trials were the focus of the review. The review found a variable contribution of high-quality studies examining the efficacy of medications for spine pain primarily in the geriatric population. There was strong evidence for NSAID use with adjustments for gastrointestinal and renal risk factors. Gabapentin and pregabalin had mixed evidence for neuropathic pain. SNRIs had good evidence for neuropathic pain and a more favorable safety profile than TCAs. Tramadol had some evidence in older patients, but more so in persons aged < 65 years. Rational therapeutic choices based on geriatric spine pain diagnosis are helpful, such as NSAIDs and acetaminophen for arthritic and myofascial-based pain, gabapentinoids or duloxetine for neuropathic and radicular pain, antispastic agents for myofascial-based pain, and combination therapy for mixed etiologies. Tramadol can be well tolerated in older patients, but has risks of cognitive and classic opioid side effects. Otherwise, opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for refractory severe pain. Whenever possible, beneficial geriatric spine pain pharmacotherapy should employ the lowest therapeutic doses with consideration of polypharmacy, potentially decreased renal and hepatic metabolism, and co-morbid medical disorders.
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Affiliation(s)
- Jonathan L Fu
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA
| | - Michael D Perloff
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA.
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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8
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Valerio P, Marzano F, Milazzo F, De Larrea AE, Placella G, Caraffa A, Rinonapoli G. Facet joint syndrome treated with interventional procedures: a review article with an update on the current evidence and practice. CURRENT ORTHOPAEDIC PRACTICE 2020; 31:571-578. [DOI: 10.1097/bco.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background:
Facet Joint Syndrome (FJS) is a common progressive disease affecting small joints of the spine and can have painful symptoms. When conservative treatment measures fail, there are a wide range of interventional procedures that can be used. Varied results have been obtained with different procedures, and standardized indications and guidelines are unclear. The authors aimed to review the most current evidence on indications, utilization of interventional procedures, results, and complication risks for the treatment of FJS.
Methods:
Customized structured electronic searches were performed in PubMed and Cochrane databases. Meta-analyses, randomized controlled trials (RCT), and systematic reviews on FJS treated with interventional minimally invasive procedures published from 1st of January 2015 to 29th of February 2020 were included. We initially selected 320 studies, and 25 studies (two meta-analyses, six systematic reviews, and 17 RCT) were selected according to inclusion and exclusion criteria.
Results:
A certain amount of improvement of pain was reported in 100% of the patients, with no significant complications reported. Most studies showed efficacy of all interventional procedures at all levels of evidence, without providing definitive data on indications and superiority of one procedure over others.
Conclusions:
The authors suggest a standardized stepladder approach to the management of FJS, with conservative measures initially and interventional procedures if those measures fail. All procedures were reported to be safe and efficient when clinically indicated and properly performed. Further studies with appropriate methodology are needed.
Level of Evidence:
Level IV.
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Affiliation(s)
- Pace Valerio
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
- Spinal Unit, The Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom
| | - Fabrizio Marzano
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
| | - Federico Milazzo
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
| | | | - Giacomo Placella
- Trauma & Orthopaedics Department, Instituto di Ricovero e Cura a Carattere Scientifico, San, Raffaele Hospital, Milan, Italy
| | - Auro Caraffa
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
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9
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Xue Y, Ding T, Wang D, Zhao J, Yang H, Gu X, Feng D, Zhang Y, Liu H, Tang F, Wang W, Lu M, Wu C. Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain. J Orthop Surg Res 2020; 15:4. [PMID: 31900227 PMCID: PMC6942342 DOI: 10.1186/s13018-019-1533-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.
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Affiliation(s)
- Yuntao Xue
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Tao Ding
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China.
| | - Dajie Wang
- Department of Anesthesiology, Thomas Jefferson University Hospital, 834 Chestnut St. T150, Philadelphia, PA, 19107, USA
| | - Jianli Zhao
- Department of Anesthesiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaofeng Gu
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Dehong Feng
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Yafeng Zhang
- Department of Orthopaedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, China
| | - Hao Liu
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
| | - Fenglin Tang
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Wanyi Wang
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Miao Lu
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299 Qingyang Road, Wuxi City, Jiangsu Province, China
| | - Chao Wu
- ECG Room, Wuxi 3rd People's Hospital, Wuxi, Jiangsu, China
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Onafowokan OO, Fine NF, Brooks F, Stokes OM, Briggs TWR, Hutton M. Multiple injections for low back pain: What’s the future? 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 2020; 29:564-578. [DOI: 10.1007/s00586-019-06258-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/04/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022]
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Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian Spine J 2018; 12:574-585. [PMID: 29879788 PMCID: PMC6002183 DOI: 10.4184/asj.2018.12.3.574] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/20/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022] Open
Abstract
The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients’ clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.
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Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J 2017; 17:1770-1780. [PMID: 28576500 DOI: 10.1016/j.spinee.2017.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/08/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. PURPOSE We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. STUDY DESIGN/SETTING A meta-analysis of randomized controlled trials was carried out. PATIENT SAMPLE Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. OUTCOME MEASURES Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. METHOD We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. RESULTS We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments. CONCLUSIONS Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwaro, Ilsan Seo-gu, Goyang, Gyeonggi, 10380, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Brain and Cognitive Sciences, 203-105B, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Velickovic M, Ballhause TM. Delayed onset of a spinal epidural hematoma after facet joint injection. SAGE Open Med Case Rep 2016; 4:2050313X16675258. [PMID: 27803810 PMCID: PMC5077070 DOI: 10.1177/2050313x16675258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.
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Affiliation(s)
- Mirko Velickovic
- Department of Orthopedic Surgery, Sports Traumatology and Trauma Surgery, Wolfenbüttel Municipal Hospital, Wolfenbüttel, Germany
| | - Tobias M Ballhause
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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