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Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
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Ojelade E, Koris J, Van-Hove M, Gray WK, Briggs TWR, Hutton M. Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England: Retrospective Analysis of an Administrative Dataset. Global Spine J 2023:21925682231203651. [PMID: 37791603 DOI: 10.1177/21925682231203651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of an administrative dataset. OBJECTIVE This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England. METHODS Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within one year of the first. The exposure of interest was two injections within 180 days or three within one year. Patients aged <17 years and where the body site was listed as cervical, thoracic or sacral were excluded. RESULTS Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180 days or three injections within one year. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the five years, enough to power 2,575 average UK homes for 1 year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20. CONCLUSIONS The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.
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Affiliation(s)
- Elizabeth Ojelade
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jacob Koris
- Getting It Right First Time Programme, NHS England, London, UK
- FMLM National Medical Director's Clinical Fellow, NHS England, London, UK
- Orthopaedic Surgery, John Radcliffe Hospital, Oxford, UK
| | - Maria Van-Hove
- Getting It Right First Time Programme, NHS England, London, UK
- Clinical Fellow, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK
| | - Tim W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mike Hutton
- Getting It Right First Time Programme, NHS England, London, UK
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Han Y, Wang X, Wang J, Sun S, Xia X, Wang J, Miao J. Influence of weight-bearing on the 3D movement of lumbar facet joints in the sitting position. BMC Musculoskelet Disord 2023; 24:561. [PMID: 37430257 DOI: 10.1186/s12891-023-06698-y] [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: 11/23/2022] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To analyze the motion characteristics of lumbar facet joints and to observe the effect of weight-bearing on lumbar facet joints in the sitting position. METHODS Ten normal subjects (5 males and 5 females) were recruited and scanned by CT, and their lumbar 3D models were reconstructed by software. The images of flexion and extension of lumbar facet joints in the sitting position were collected without weight-bearing and weight-bearing 10 kg, and the 2D model was constructed by software. The 2D-3D model was matched to restore the flexion and extension motion changes of the subjects' lumbar spine in the sitting position. Coordinates were established in the middle of the vertebral body and copied to the facet joints. Measure and record the lumbar facet joint movement distance through coordinate system. The relevant data of facet joints were collected. RESULTS In the L3/4 segment, after weight loading, the displacement of the left facet joint in the X axis became larger, while that in the Y axis and Z axis decreased. The displacement of the right facet joint in the X axis and Y axis increased, and the Z axis displacement decreased. The rotation angle of the bilateral facet joints also decreased. In the L4/5 segment, after loading, the displacements of the X, Y, and Z axis displacements of both sides increase, while the rotation angles of α and β increase, while the rotation angle of γ decreases. In the L5/S1 segment, the displacements of the X, Y, and Z axes on the left side decrease. The displacement of the X and Y axes on the right side decreases, while the displacement on the Z axis increases. The rotation angles of α and γ increase, and the rotation angle of the β axis decreases. CONCLUSION When sitting, the flexion and extension distance and rotational displacement of lumbar facet joints are not affected by weight-bearing. In addition, there is asymmetry in the movement of the left and right facet joints, and weight bearing has no effect on the asymmetry of the motion.
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Affiliation(s)
- Ye Han
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Xiaodong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Jianzhong Wang
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Shaosong Sun
- Department of Orthopedics, The Affiliated Hospital of Hebei University, Hebei, China
| | - Xi Xia
- Department of Orthopedics, Baoding First Central Hospital, Hebei, China
| | - Jing Wang
- Department of Orthopedics, Gaoyang County Hospital, Hebei, China
| | - Jun Miao
- Department of Orthopedics, Tianjin Hospital of Tianjin University, Tianjin, China.
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Akgul MH, Akgun MY. Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study. Heliyon 2022; 8:e10755. [PMID: 36193536 PMCID: PMC9526146 DOI: 10.1016/j.heliyon.2022.e10755] [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: 05/16/2022] [Revised: 07/13/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Low back pain is the leading cause of job-related disabilities. The zygapophyseal (facet) joint has been identified as a cause of spinal pain in 15%–45% of individuals. Radiofrequency ablation (RFA) to the facet joints of the lumbar, cervical and thoracic regions and discussion of the 2-year follow-up results will provide additional data and contribute to understanding the long-term effectiveness of RFA. Methods Patients with cervical, thoracic or low back pain, not accompanied by radicular pain and without primary and/or metastatic disease in the spinal region during radiological evaluation were retrospectively analysed. A total of 1274 patients aged >18 years who had clinical follow-up for at least 1 year and had back pain for >6 months were included in the study. The RFA groups were compared within themselves before and after the application. Moreover, patients who received RFA were compared with those who did not receive RFA (controls). The visual analogue scale and quality-of-life scores of the patients were evaluated. Periodic clinical follow-ups revealed changes in neurological status. Results Of the 774 patients who underwent RFA, 156, 184 and 434 patients had pain in the cervical, thoracic and lumbar and lumbosacral regions, respectively. The control groups consisted of 108, 122 and 270 patients, respectively. No significant difference in any of the baseline demographic variables was observed between the groups (p > 0.05). A significant improvement was found in both visual analogue scale and quality-of-life scores when compared before and after RFA application within the groups. In addition, a significant improvement was found in the RFA group compared with the control group. Conclusions As far as we know, this is the first comparative study of RFA involving the cervical, thoracic and lumbar spinal regions. RFA made it possible to obtain satisfactory results in all three regions. With its increasing popularity and frequency of use, new indications for RFA may emerge. Radiofrequency ablation (RFA) method emerges as a very successful treatment method in patients who do not have an operative pathology but who suffer from chronic pain. Especially, considering the persistent outpatient clinic admissions of patients with persistent low back pain, RFA is a "rescuer" position for most clinicians. The clinical relief of the patients for two years is one of the most critical data clearly demonstrating the long-term success of the procedure.
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Gupta M, Ray M, Ladesich N, Gupta A. Health-Care Utilization and Outcomes with 10 kHz Spinal Cord Stimulation for Chronic Refractory Pain. J Pain Res 2021; 14:3675-3683. [PMID: 34880672 PMCID: PMC8648088 DOI: 10.2147/jpr.s306126] [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: 02/10/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic pain is a common condition associated with decreased quality of life and increased health-care costs. Opioid analgesics are routinely used to treat chronic pain despite limited evidence of long-term efficacy. Spinal cord stimulation at a frequency of 10 kilohertz (10kHz-SCS) has been shown to be effective for treating chronic pain. Objective This study was conducted to evaluate the effects of 10kHz-SCS on patients’ pain intensity, volume of pain interventions, and opioid intake in a real-world setting. Study Design This study was a retrospective review of patient data. Setting The study was conducted at a single, community-based clinic. Methods Outcomes including pain relief, quality of life, opioid intake, and rate of health-care usage were evaluated using data from patients who were implanted with a 10kHz-SCS device to treat chronic pain. These outcomes were then compared for the pre- and post-implant periods. Results A total of 47 patients with a mean follow-up duration of 15.6 ± 6.2 months were included in this analysis. Mean pain relief was 73 ± 22% and 89% were responders at the final follow-up visit. The rate of medical interventions fell from 3.48±3.05 per year before starting 10kHz-SCS to 0.49±1.16 per year afterward (P < 0.001). Of 30 patients with available opioid consumption data, 89% maintained or decreased their intake after implant. Conclusion Retrospective data from a single center, with minimal exclusion criteria shows clinically significant pain relief with 10kHz-SCS, accompanied by significant indirect benefits including stable or reduced opioid use and reduced interventional procedures.
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Affiliation(s)
- Mayank Gupta
- Neuroscience Research Center, LLC, Overland Park, KS, USA
| | - Mahoua Ray
- Neuroscience Research Center, LLC, Overland Park, KS, USA
| | | | - Akshat Gupta
- Neuroscience Research Center, LLC, Overland Park, KS, USA
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Ozcamdalli M, Misir A, Oguzkaya S, Kizkapan TB, Turk OI, Uzun E. The effect of lumbar facet joint injection levels on spinopelvic parameters and functional outcome. J Back Musculoskelet Rehabil 2021; 34:103-109. [PMID: 33104017 DOI: 10.3233/bmr-200067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain is a very common musculoskeletal complaint that impacts patients' quality of life in numerous ways. Facet joint injection is a widely used spinal intervention to relieve back pain. Effects of facet joint injection on spinopelvic parameters and the relationship between injection levels and spinopelvic parameter changes have not been evaluated before. OBJECTIVE To compare spinopelvic parameters before and after injections at different levels, and to evaluate the correlation between these changes and functional outcome. METHODS 144 patients were included in the study and retrospectively grouped by injection level: Group 1 (n= 72), L4-L5 and L5-S1, and group 2 (n= 72), L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1. Pre- and post-injection Oswestry Disability Index (ODI), sacral slope, pelvic tilt, pelvic incidence, and intervertebral angles between T12 and S1 were compared. The correlation between ODI and radiographic parameter changes was evaluated. RESULTS The pre- to post-injection ODI change was significantly lower in group 2 (p= 0.010). There was no significant difference between the groups in terms of pre- and post-injection spinopelvic parameters before and after injection (p> 0.05) except pelvic tilt (p= 0.001 and p= 0.007, respectively). There was a significant moderate positive correlation between the change in the ODI value and the change in pelvic tilt (P= 0.012, r= 0.581). CONCLUSIONS Multilevel lumbar facet injections are clinically more effective than only two-level lower level lumbar injections. Pelvic tilt changes positively correlate with the ODI score changes.
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Affiliation(s)
- Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Gaziosmanpasa Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Sinan Oguzkaya
- Department of Orthopaedics and Traumatology, Sivas Sarkisla State Hospital, Sivas, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Ozgur Ismail Turk
- Department of Orthopaedics and Traumatology, Sirnak Cizre State Hospital, Sirnak, Turkey
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Baroncini A, Maffulli N, Eschweiler J, Knobe M, Tingart M, Migliorini F. Management of facet joints osteoarthritis associated with chronic low back pain: A systematic review. Surgeon 2021; 19:e512-e518. [PMID: 33582054 DOI: 10.1016/j.surge.2020.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Facet joint injections (FJI) and medial branch blocks (MBB) can be employed for chronic low back pain (LBP) using different drugs such as corticosteroids, hyaluronic acid, sarapin and local anaesthetics. This systematic review compares the results of injections obtained with different compounds in the management LBP originating from facet joints. METHODS The present systematic review was conducted according to the PRISMA statement. The literature search was performed in October 2020. All the randomized clinical trials concerning injection treatments for chronic LBP. Drugs rather than steroids, hyaluronic acid, anaesthetics and sarapin were not considered, as well as those reporting outcomes from combined treatments. The Oswestry Disability Index (ODI) and the numeric rating scale (NRS) were retrieved. RESULTS Data from 587 patients were retrieved. The mean follow-up was 12.4 ± 10.5 months. The mean age was 51.3 ± 9.6 years old. 57% (335/587) of patients were women. Steroids promoted a reduction of NRS by 28% (P < 0.0001) and an improvement of the ODI by 13.2% (P = 0.005), and local anaesthetics produced an improvement of the ODI by 9.8% (P < 0.0001). Sarapin resulted in a reduction of NRS by 44% (P = 0.04) and an improvement the ODI by 14.9% (P = 0.004); sarapin combined with steroids promoted a reduction of NRS by 47% (P = 0.04) and an improvement of the ODI by 11.7% (P = 0.001). CONCLUSION Injections for chronic LBP deriving from facet joints osteoarthritis are encouraging, especially when considering MBB. LEVEL OF EVIDENCE I, systematic review of RCTs.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, United Kingdom; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, United Kingdom.
| | - Joerg Eschweiler
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Markus Tingart
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
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Hadzimuratovic B, Mittelbach A, Bahrami A, Zwerina J, Kocijan R. Confluent abscesses in autochthonous back muscles after spinal injections : A case report and narrative review of the literature on low back pain and spinal injections. Wien Med Wochenschr 2020; 172:247-255. [PMID: 32748365 DOI: 10.1007/s10354-020-00773-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Injection therapy is a frequently used method for the treatment of subacute and chronic low back pain (LBP) despite scant evidence for its effectiveness. To date there are relatively few studies comparing this method with other treatments. Moreover, there are many possible side effects associated with injection therapies, some of which are potentially life threatening. We present the case of a 59-year-old woman admitted to the emergency department with confluent abscess formations of autochthonous back muscles and staphylococcal sepsis caused by injection therapy performed by a general practitioner for LBP. The findings of this case report emphasize a careful selection of patients for this type of treatment and a multidisciplinary approach to treatment of LBP.
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Affiliation(s)
- Benjamin Hadzimuratovic
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Andreas Mittelbach
- Institut für Physikalische Medizin und Rehabilitation, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Arian Bahrami
- Zentralröntgeninstitut mit Fachbereich Nuklearmedizin, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, I. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Heinrich Collin-Straße 30, 1140, Vienna, Austria.
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