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Yan D, Zubair AC, Osborne MD, Pagan-Rosado R, Stone JA, Lehman VT, Durand NC, Kubrova E, Wang Z, Witter DM, Baer MM, Ponce GC, Quiñones-Hinojosa A, Qu W. CellKine clinical trial: first report from a phase 1 trial of allogeneic bone marrow-derived mesenchymal stem cells in subjects with painful lumbar facet joint arthropathy. Pain Rep 2024; 9:e1181. [PMID: 39300992 PMCID: PMC11412710 DOI: 10.1097/pr9.0000000000001181] [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: 12/22/2023] [Revised: 06/13/2024] [Accepted: 06/30/2024] [Indexed: 09/22/2024] Open
Abstract
Background Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow-derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA. Objectives This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA. Methods Following enrollment in our IRB-approved protocol, symptomatic LFJA was confirmed through double blocks on L4 and L5 medial branches. Two 1-mL syringes, each containing 10 million BM-MSCs, were prepared in the cGMP facility and administered bilaterally to the patient's L4-L5 lumbar facet joints. The patient underwent standardized follow-ups, including clinical examinations and functional and imaging assessments for 2 years, utilizing patient-reported outcomes measurement information system-computer adaptive tests (PROMIS CATs), visual analogue scale, Oswestry disability index, work functional status and opioid pain medication use, and MR imaging Fenton-Czervionke score. Results The patient tolerated the procedure well, with no drug-related adverse events during the study period. Pain, spine function, and work functional status improved at multiple follow-ups. This patient also reported improvements in mental and social health, along with a notable improvement in the grade of facet synovitis observed at the one-year follow-up MRI evaluation. Conclusions This case report suggests the safety and feasibility of administering intra-articular allogeneic BM-MSCs, offering therapeutic benefits for pain management and functional activities.
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Affiliation(s)
- Dan Yan
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Abba C Zubair
- Transfusion Medicine, Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nisha C Durand
- Transfusion Medicine, Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
- Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Drew M Witter
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Meghan M Baer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Gabriela C Ponce
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA
- Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA
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Scholten P, Sheikh M, Atchison J, Eldrige JS, Garcia D, Sandhu S, Qu W, Nottmeier E, Fox WC, Buchanan I, Pirris S, Chen S, Quinones-Hinojosa A, Abode-Iyamah K. Correlating SPECT-CT activity in lumbar facet joints with response to lumbar medial branch and L5 dorsal ramus blocks. INTERVENTIONAL PAIN MEDICINE 2024; 3:100387. [PMID: 39239486 PMCID: PMC11372969 DOI: 10.1016/j.inpm.2024.100387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 09/07/2024]
Abstract
Introduction Lumbar facet arthritis is a significant source of back pain and impaired function that is amenable to treatment with medial branch radiofrequency neurotomy (RFN). Identifying appropriate patients for this treatment requires integration of information from the history, physical exam, and diagnostic imaging, but the current diagnostic standard for facet-mediated pain is positive comparative medial branch blocks (MBBs). Lumbar SPECT-CT has recently been evaluated as a potential predictor of positive MBBs with mixed results. The purpose of this retrospective analysis was to determine if the level of concordance between SPECT-CT uptake and facet joints targeted with MBB was associated with a positive block. Methods A retrospective review was performed to identify all patients undergoing lumbar MBB within 12 months after having a lumbar SPECT-CT. Each procedure was classified into one of four categories based on the level of concordance between facet joints demonstrating increased 99mTc uptake on SPECT-CT and those being blocked: 1) Complete Concordance (all joints demonstrating increased uptake were blocked and no additional joints blocked); 2) Partial Concordance (all joints demonstrating increased uptake were blocked, with at least one joint not demonstrating increased uptake blocked); 3) Partial Discordance (at least one but not all joints demonstrating increased uptake were blocked); 4) Complete Discordance (all blocks performed at joints not demonstrating increased uptake). Statistical analysis was performed to determine if the level of concordance between increased uptake on SPECT-CT and joints undergoing MBB was associated with a positive block using cutoffs of 50 % and 80 % pain relief. Results A total of 180 procedures were analyzed (23 % Complete Concordance, 22 % Partial Concordance, 31 % Partial Discordance, 24 % Complete Discordance) and all groups demonstrated improvement in pain Numeric Rating Scale (NRS) scores. There was no significant association between level of concordance and having a positive block using thresholds of 50 % pain relief, χ 2(3, N = 180) = 4.880, p = .181; or 80 % pain relief, χ 2(3, N = 180) = 1.272, p = .736. Conclusion SPECT-CT findings do not accurately predict positive lumbar MBB but may provide valuable information that can be considered with other factors when deciding which joints to treat.
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Affiliation(s)
- Paul Scholten
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Mateen Sheikh
- University of North Florida, 1 UNF Dr., Jacksonville, FL, 32224, USA
| | - James Atchison
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Jason S Eldrige
- Department of Pain Medicine, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Diogo Garcia
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sukhwinder Sandhu
- Department of Neuroradiology, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Eric Nottmeier
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - W Christopher Fox
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ian Buchanan
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Stephen Pirris
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Selby Chen
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Alfredo Quinones-Hinojosa
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kingsley Abode-Iyamah
- Departement of Neurologic Surgery, Mayo Clinic Florida, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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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.)
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Acevedo-González JC, Taub-Krivoy A. Tension Distension Sign (Acevedo's Sign) for the Diagnosis of Lumbar Facet Syndrome: Technical Note. World Neurosurg 2023; 179:167-170. [PMID: 37648199 DOI: 10.1016/j.wneu.2023.08.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
The treatment of low back pain has evolved from an understanding of its pathophysiology, biomechanics, and therapy. The events that characterize the degenerative cascade of modifications that produce pain are well described. Facet joints are early affected when there is a loss of intervertebral disc height and may present biomechanical overload that translates into pain. Clinical diagnosis of lumbar facet syndrome is not straightforward because there are no specific features other than pain triggered by hyperextension + forced rotation of the lumbar spine in a standing position to suspect it. This implies that its diagnostic confirmation depends on bone scintigraphy and selective anesthetic blockade of the dorsal and medial branches of the joint. In this technical note, we present a new clinical sign (Tension Distension Signo sign/Acevedo's sign) described since 2004.
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Affiliation(s)
- Juan Carlos Acevedo-González
- Neurosurgeon Specialized in Functional Neurosurgery, Pain Management and Spasticity, Pontifical Xaverian University, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Alex Taub-Krivoy
- Neuroscience and Neurosurgery Department, Pontifical Xaverian University, Hospital Universitario San Ignacio, Bogotá, Colombia
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Baker SA, Billmire DA, Bilodeau RA, Emmett D, Gibbons AK, Mitchell UH, Bowden AE, Fullwood DT. Wearable Nanocomposite Sensor System for Motion Phenotyping Chronic Low Back Pain: A BACPAC Technology Research Site. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S160-S174. [PMID: 36799544 PMCID: PMC10403308 DOI: 10.1093/pm/pnad017] [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: 09/28/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
Chronic low back pain (cLBP) is a prevalent and multifactorial ailment. No single treatment has been shown to dramatically improve outcomes for all cLBP patients, and current techniques of linking a patient with their most effective treatment lack validation. It has long been recognized that spinal pathology alters motion. Therefore, one potential method to identify optimal treatments is to evaluate patient movement patterns (ie, motion-based phenotypes). Biomechanists, physical therapists, and surgeons each utilize a variety of tools and techniques to qualitatively assess movement as a critical element in their treatment paradigms. However, objectively characterizing and communicating this information is challenging due to the lack of economical, objective, and accurate clinical tools. In response to that need, we have developed a wearable array of nanocomposite stretch sensors that accurately capture the lumbar spinal kinematics, the SPINE Sense System. Data collected from this device are used to identify movement-based phenotypes and analyze correlations between spinal kinematics and patient-reported outcomes. The purpose of this paper is twofold: first, to describe the design and validity of the SPINE Sense System; and second, to describe the protocol and data analysis toward the application of this equipment to enhance understanding of the relationship between spinal movement patterns and patient metrics, which will facilitate the identification of optimal treatment paradigms for cLBP.
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Affiliation(s)
- Spencer A Baker
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darci A Billmire
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - R Adam Bilodeau
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darian Emmett
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Andrew K Gibbons
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - David T Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
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Özcan-Ekşi EE, Börekci A, Ekşi MŞ. Facet Joint Orientation/Tropism Could Be Associated with Fatty Infiltration in the Lumbar Paraspinal Muscles. World Neurosurg 2023; 173:e606-e615. [PMID: 36863453 DOI: 10.1016/j.wneu.2023.02.111] [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: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level. METHODS Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging. RESULTS Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively. CONCLUSIONS Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.
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Affiliation(s)
- Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
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Safety and Efficacy of Autologous Stem Cell Treatment for Facetogenic Chronic Back Pain. J Pers Med 2023; 13:jpm13030436. [PMID: 36983621 PMCID: PMC10058908 DOI: 10.3390/jpm13030436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Background: Chronic back pain due to facet joint syndrome is a common and debilitating condition. Advances in regenerative medicine have shown that autologous unmodified adipose tissue-derived regenerative cells (ADRC) provide several beneficial effects. These regenerative cells can differentiate into various tissues and exhibit a strong anti-inflammatory potential. ADRCs can be obtained from a small amount of fatty tissue derived from the patient’s abdominal fat. Methods: We report long-term results of 37 patients (age 31–78 years, mean 62.5) suffering from “Facet Joint Syndrome” The pathology was confirmed by clinical, radiological examinations and fluoroscopically guided test injections. Then, liposuction was performed. An amount of 50–100 cc of fat was harvested. To recover stem cells from adipose tissue, we use the CE-certified Transpose RT™ system from InGeneron GmbH. The cells were then injected under fluoroscopic control in the periarticular fat. Follow-up examinations were performed at 1 week, 1 year, and 5 years. Results: Every patient reported improved VAS pain at any follow-up (1 week, 1 year, and 5 years) with ADRCs compared to the baseline. Conclusions: Our observational data indicate that facet joint syndrome patients treated with unmodified adipose tissue-derived regenerative cells experience improved the quality of life in the long term.
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Kvasnitskyi MV. RADIOFREQUENCY DENERVATION OF THE FACET JOINTS AND LOCAL PERIARTICULAR ADMINISTRATION OF ANAESTHETICS IN FACET SYNDROME TREATMENT. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2609-2613. [PMID: 36591741 DOI: 10.36740/wlek202211110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To determine the effectiveness of radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics in patients with facet syndrome. PATIENTS AND METHODS Materials and methods: The early and long-term results of treatment patients with facet syndrome were analysed. The Visual Analogue Scale of pain and the Oswestry Disability Index were used. The 47 patients underwent radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics (the main group). The 136 patients underwent only radiofrequency denervation of the facet joints (control group). RESULTS Results: Immediately after the treatment as well as in 3 months and in 1 year after it, a reliable results of treatment of facet syndrome in both the main and the control groups was attained. At the same time, there were significant differences between the main group and the control group immediately after treatment. But in 3 months and in 1 year after it there were no such differences that proved a significantly higher efficiency of high radiofrequency denervation of facet joints in combination with periarticular administration of local anaesthetics in the early postoperative period. CONCLUSION Conclusions: The radiofrequency denervation of the facet joints has proved to be an effective method of treatment of patients with spondyloarthritis both in the short and long term outcomes. Periarticular administration of local anaesthetics enhances the effectiveness of radiofrequency denervation of the facet joints only for the short term outcomes.
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Affiliation(s)
- Mykola V Kvasnitskyi
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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Sex-Based Differences in Age-Related Changes of the Vertebral Column from a Bronze Age Urban Population in Ancient China. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The health disparities between males and females in bioarchaeological settings are important indicators of gender-based differences in socioeconomic roles. In this study, sex-based differences of the vertebral column in spine pathology were investigated in human skeletons excavated from a Bronze Age cemetery of the Western Zhou Dynasty at the Dahekou site in Shanxi, China. Results demonstrated that females had a higher prevalence of vertebral compressive fractures, with the majority found in those between twenty-five and thirty years old, suggesting that the fractures were a consequence of osteoporosis and its early onset in females. In contrast, males expressed overall more severe ageing in all vertebral divisions compared to females. Males also had a higher prevalence of vertebral facet joint osteoarthritis in cervical and thoracic divisions than females. Likewise, the incidence of facet joint osteoarthritis was more asymmetric between the left and right joints in males than in females. These findings reflect disparities of vertebral health between the two sexes in an urban setting, in which ageing and injuries of the vertebral column might be driven by different mechanisms. Age-related changes in female vertebral columns may have been more influenced by conditions of hormone deficiency such as menopause, while male vertebral columns might have been more prone to age-related changes due to heavy labor-induced physical stressors. Further studies on the differentiation of ageing mechanisms between the two sexes based on physiology, socioeconomic roles, and living conditions are warranted. The studies are necessary in understanding how multiple sociocultural and physiological factors contribute to health disparities in historic and contemporary environments.
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Arora P, Kanthed P, Vyas N, Dey S. Minimally invasive pain and spine interventions for low backache. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Klahsen O, Clark AL, Brown SHM. Investigating how combined multifidus injury and facet joint compression influence changes in surrounding muscles and facet degeneration in the rat. 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 2021; 30:2613-2621. [PMID: 34050807 DOI: 10.1007/s00586-021-06877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine whether unilateral multifidus damage could promote degeneration at the L5-6 facet joint (FJ) and compensatory changes in lumbo-pelvic muscles in rats. METHODS 12 facet clamp, 12 facet sham and 7 control rats were studied. Facet clamp and sham animals had the left L5-6 FJ exposed, and the clamp group had a mild compressive clamp applied using hemostatic forceps to model post-traumatic arthritis. Both groups then had the left multifidus detached from the L1-L6 spinous processes. Animals were euthanized 28 days post-surgery. Muscle mass and fascicle length were evaluated bilaterally for the paraspinal muscles, gluteal muscles and biceps femoris. Intra-muscular collagen of the paraspinal muscles was measured histologically. FJ transverse plane angles were measured from micro-computed tomography scans. L5-6 FJ degeneration was evaluated through the 24-point OARSI scale. RESULTS Differences, compared to control, were observed in the detached multifidus from both facet clamp and sham groups; namely decreased mass and fascicle length and increased collagen content. However, no between group differences were found for any other muscle. Further, mild FJ degeneration was more prevalent in the groups that had experienced multifidus injury but was not exacerbated by the mild compressive clamping of the FJ. CONCLUSION Unilateral multifidus injury with or without FJ compressive clamping does not have a clear impact on the characteristics of surrounding spinal musculature within 28 days post-surgery in rats. Mild FJ degeneration was present in some animals from all three groups, and the impact of multifidus injury on this degeneration is inconclusive.
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Affiliation(s)
- Olena Klahsen
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Andrea L Clark
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
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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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Dillingham TR, Annaswamy TM, Plastaras CT. Evaluation of persons with suspected lumbosacral and cervical radiculopathy: Electrodiagnostic assessment and implications for treatment and outcomes (Part II). Muscle Nerve 2020; 62:474-484. [PMID: 32564381 DOI: 10.1002/mus.27008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
The electrodiagnostic (EDX) examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and complements imaging of the spine. In this second of a two-part review, the implications of electrodiagnostic findings for diagnosis and clinical management of persons with radiculopathy are reviewed. An EMG confirmed lumbosacral radiculopathy is associated with better clinical outcomes for persons undergoing aggressive conservative management. A positive EMG test portends a better clinical response to epidural corticosteroid injections. If a person undergoes spine surgery, a positive pre-operative EMG for radiculopathy is also associated with better outcomes.
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Affiliation(s)
- Timothy R Dillingham
- Department of Physical Medicine and Rehabilitation, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thiru M Annaswamy
- Electrodiagnostic and Spine Sections, VA North Texas Health Care System, Dallas VA Medical Center, Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher T Plastaras
- Musculoskeletal Spine & Sports Rehabilitation Medicine, MossRehab, Einstein Spine Institute, Co-Chair, Albert Einstein Healthcare Network, Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, Hooten WM, Hurley RW, Kennedy DJ, McLean BC, Moon JY, Narouze S, Pangarkar S, Provenzano DA, Rauck R, Sitzman BT, Smuck M, van Zundert J, Vorenkamp K, Wallace MS, Zhao Z. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020; 45:424-467. [PMID: 32245841 PMCID: PMC7362874 DOI: 10.1136/rapm-2019-101243] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4-5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. RESULTS 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). CONCLUSIONS Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.
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Affiliation(s)
- Steven P Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Arun Bhaskar
- Anesthesiology, Imperial College Healthcare NHS Trust Haemodialysis Clinic Hayes Satellite Unit, Hayes, UK
| | - Anuj Bhatia
- Anesthesia and Pain Management, University of Toronto and University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Tim Deer
- Spine & Nerve Centers, Charleston, West Virginia, USA
| | - Shuchita Garg
- Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Robert W Hurley
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David J Kennedy
- Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Brian C McLean
- Anesthesiology, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA
| | - Jee Youn Moon
- Dept of Anesthesiology, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Sanjog Pangarkar
- Dept of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Richard Rauck
- Carolinas Pain Institute, Winston Salem, North Carolina, USA
| | | | - Matthew Smuck
- Dept.of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford Medicine, Stanford, California, USA
| | - Jan van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Mark S Wallace
- Anesthesiology, UCSD Medical Center-Thornton Hospital, San Diego, California, USA
| | - Zirong Zhao
- Neurology, VA Healthcare Center District of Columbia, Washington, District of Columbia, USA
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15
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Bermel EA, Thakral S, Claeson AA, Ellingson AM, Barocas VH. Asymmetric in-plane shear behavior of isolated cadaveric lumbar facet capsular ligaments: Implications for subject specific biomechanical models. J Biomech 2020; 105:109814. [PMID: 32423548 PMCID: PMC7336028 DOI: 10.1016/j.jbiomech.2020.109814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2020] [Accepted: 04/19/2020] [Indexed: 01/24/2023]
Abstract
The facet capsular ligaments (FCLs) flank the spinous process on the posterior aspect of the spine. The lumbar FCL is collagenous, with collagen fibers aligned primarily bone-to-bone (medial-lateral) and experiences significant shear, especially during spinal flexion and extension. We characterized the mechanical response of the lumbar FCL to in-plane shear, and we evaluated that response in the context of the fiber architecture. In-plane shear tests with both positive and negative shear (i.e., corresponding to flexion and to extension) were performed on eight cadaveric human L4-L5 FCLs. Our most striking observation was subject-dependent asymmetry in the response. All samples showed a toe region of low stiffness, transitioning to greater stiffness at higher strains, for both shear directions. Different samples showed profoundly different transition strains, with some samples stiffening more rapidly in positive shear and some in negative shear. This unpredictable asymmetry, which did not correlate with age, side, or degeneration state, suggesting that collagen fibers in the FCL are sometimes aligned at a slight positive angle from the bone-to-bone axis and sometimes at a negative angle. Fitting the experimental data to a fiber-composite-based finite element model supported this idea, yielding optimal fits with positive or negative off-axis fiber directions (-40° to +40°). Subsequent examination of selected FCLs by small-angle x-ray scattering (SAXS) showed a similar variability in fiber direction. We conclude that small individual differences in lumbar FCL architecture may have a significant effect on lumbar FCL mechanics, especially at moderate strains.
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Affiliation(s)
- Emily A Bermel
- University of Minnesota, Biomedical Engineering, 312 Church St. SE, 7-105 Nils Hasselmo Hall, Minneapolis, MN 55455, United States.
| | - Seema Thakral
- University of Minnesota, Characterization Facility, 100 Union St. SE, 14 Shepherd Labs, Minneapolis, MN 55455, United States.
| | - Amy A Claeson
- Zimmer Biomet Spine, 10225 Westmoor Dr., Westminster, CO 80021, United States.
| | - Arin M Ellingson
- University of Minnesota, Department of Rehabilitation Medicine, Divisions of Physical Therapy and Rehabilitation Science, 420 Delaware St SE, MMC 388, Minneapolis, MN 55455, United States.
| | - Victor H Barocas
- University of Minnesota, Biomedical Engineering, 312 Church St. SE, 7-105 Nils Hasselmo Hall, Minneapolis, MN 55455, United States.
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Puerto-Vázquez M, Vicario-Espinosa C, Criado-Álvarez J, Marco-Martínez F. Development of a calculator to establish indications to refer patients with lumbar degenerative disease for spinal surgery consultation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Puerto-Vázquez MG, Vicario-Espinosa C, Criado-Álvarez JJ, Marco-Martínez F. Development of a calculator to establish indications to refer patients with lumbar degenerative disease for spinal surgery consultation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:177-184. [PMID: 32171672 DOI: 10.1016/j.recot.2019.12.003] [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: 08/18/2019] [Revised: 10/16/2019] [Accepted: 12/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist.
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Affiliation(s)
| | - C Vicario-Espinosa
- Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - J J Criado-Álvarez
- Centro de Salud de La Pueblanueva, Gerencia de Atención Integrada de Talavera de la Reina, SESCAM, San Bartolomé de las Abiertas, Toledo, España
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18
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Spondyloarthrosis: pathogenesis, clinic, diagnosis and treatment (literature review and own experience). КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract18813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.
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19
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Akuthota V, Meron AJ, Singh JR, Boimbo S, Laker SR, Brakke Holman R, Sridhar BV, Friedrich J, Sullivan WJ. The utility of magnetic resonance imaging results in physician decision-making before initial lumbar spinal injection. Spine J 2019; 19:1455-1462. [PMID: 31009770 DOI: 10.1016/j.spinee.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The need for advanced imaging before spinal intervention is an area of ongoing debate. Many studies have demonstrated the accuracy of magnetic resonance imaging (MRI) results in evaluating structural pathology in the lumbar spine, but few have addressed how frequently MRI findings change clinical management. A randomized controlled trial showed that viewing MRI results did not impact outcomes in patients with radiculopathy undergoing epidural steroid injection (ESI). The results suggested ESIs that correlated with both imaging and clinical findings experienced slightly more benefit than the blinded cohort, although statistically insignificantly. PURPOSE Three related studies were conducted to (1) increase understanding of the opinions of interventional spine physicians regarding the utility of viewing imaging before injection and (2) evaluate the impact of viewing MRI results on injection planning (retrospective and prospective analyses). STUDY DESIGN Survey, prospective, and retrospective analysis. PATIENT SAMPLE Patients presenting to a university-based spine center for initial evaluation of back or leg pain who were candidates for spinal intervention. OUTCOME MEASURES Self-reported measures from a clinical practice questionnaire distributed to interventional spine physicians to determine rates and rationale for utilization of MRI before spine injection, physiologic measures including MRI results, functional measures including physician decision-making regarding type and location of injection performed. METHODS This study was funded by the University of Colorado Health and Welfare Trust. A survey was sent to interventional spine physicians to assess their utilization of MRI results before spine procedures. A retrospective analysis of patients who were candidates for ESI was conducted to evaluate how initial injection plan compared with the postviewing of MRI results on injection performed. In a prospective analysis, injection plans pre- and post-MRI were compared among patients presenting for initial evaluation of low back or leg pain. RESULTS Survey responses showed that specialists order MRI studies to correlate with physical exam (91%) and to detect the presence of synovial cysts (68%), whereas tumor/infection (93%) was most likely to cause a change in their approach. In the retrospective review, the physician's planned approach before viewing the MRI was concordant with the actual procedure 49% of the time. A different type of procedure was performed in 15% of planned injections. In such cases, the initial treatment plan was altered (ie, same procedure at a different or additional level or side) in 35% of planned injections. In the prospective data collection, 43% of injections were different from the initial physician decision. The most common reasons for altering the injection was different level affected (36%), facet pathology (22%), and different nerve root affected (16%). CONCLUSIONS In clinical practice, MRI before injection frequently changes management decisions in the planning and delivery of lumbar spine injections.
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Affiliation(s)
- Venu Akuthota
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA.
| | - Adele J Meron
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Jaspal Ricky Singh
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Sandra Boimbo
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Scott R Laker
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Rachel Brakke Holman
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Balaji V Sridhar
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - Jason Friedrich
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
| | - William J Sullivan
- University of Colorado, Department of Physical Medicine and Rehabilitation, 12631 E. 17th Ave, Mail Stop F493, Academic Office 1 (AO1), Room 2510, Aurora, Colorado 80045, USA
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20
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Balázsfi M, Kis D, Tóth T, Zsoldos T, Barzó P. Radiofrequency facet joint denervation efficiency based on the severity of spondylarthrosis and in osteoporotic vertebral compression fractures. A retrospective study. Clin Neurol Neurosurg 2019; 186:105497. [PMID: 31563692 DOI: 10.1016/j.clineuro.2019.105497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Radiofrequency denervation of the facet joints is performed via a well-established method. Its primary, direct indication is a positive response to a nerve block injection (MBB). Our study aimed to find other, effective but indirect indication signs through the retrospective analysis of our patients treated earlier. PATIENTS AND METHODS In our institute between 1 January, 2008 and 31 December, 2017 facet joint denervation has been performed in more than 2000 cases, and we included 529 patients in our retrospective study. We had separate groups for vertebral compression fractures and for spondylarthrosis of different severity (Grade 1; 2-3; 4), thus we assessed the postoperative condition of these patients using Visual Analoge Scale (VAS). The efficacy of the intervention was examined in every groups separately according to symptoms and previous spine surgeries. RESULTS In view of our results, chronic lumbago and dorsalgia that are attributable to osteoporotic vertebral compression fracture are obvious indications if they do not respond to conservative therapy, as 76.8% of such patients remained asymptomatic for minimum 6 months (p = 0,000). Another indication is Grade 2 or 3 chronic spondylarthrosis without radicular involvement, since these groups reported a 51.4% success rate (asymptomatic for minimum 6 months) (p = 0,015). Long term pain relief is obviously impaired by the presence of radicular compression, as we were not able to decrease the pain of 97% of such patients. Our findings also suggest that the vast majority of those who have previously undergone spine surgery cannot benefit from the intervention. CONCLUSION Based on this study, facet joint denervation can serve as an effective therapy supplement in a properly selected group of patients who do not respond to oral NSAIDs, exercise and physiotherapy. By this procedure we found we can reach long term benefit in the groups of osteoporotic vertebral fracture patients and patients with moderate spondylarthrosis. According to our results and the literature datas the properly patient selection for the indication of the RF ablation can be as effective as the controversial diagnostic nerve block injections.
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Affiliation(s)
- Márton Balázsfi
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Csongrad County, Hungary.
| | - Dávid Kis
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Csongrad County, Hungary
| | - Tamás Tóth
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Csongrad County, Hungary
| | - Tamás Zsoldos
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Csongrad County, Hungary
| | - Pál Barzó
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Csongrad County, Hungary
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Unilateral Osteotomy of Lumbar Facet Joint Induces a Mouse Model of Lumbar Facet Joint Osteoarthritis. Spine (Phila Pa 1976) 2019; 44:E930-E938. [PMID: 30896583 DOI: 10.1097/brs.0000000000003023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The lumbar facet joint (LFJ) osteoarthritis (OA) model that highly mimics the clinical conditions was established and evaluated. OBJECTIVE Here, we innovatively constructed and evaluated the aberrant mechanical loading-related LFJ OA model. SUMMARY OF BACKGROUND DATA LFJ is the only true synovial joint in a functional spinal unit in mammals. The LFJ osteoarthritis is considered to contribute 15% to 45% of low back pain. The establish of animal models highly mimicking the clinical conditions is a useful tool for the investigation of LFJ OA. However, the previously established animal models damaged the LFJ structure directly, which did not demonstrate the effect of aberrant mechanical loading on the development of LFJ osteoarthritis. METHODS In the present study, an animal model for LFJ degeneration was established by the unilateral osteotomy of LFJ (OLFJ) in L4/5 unit to induce the spine instability. Then, the change of contralateral LFJ was evaluated by morphological and molecular biological techniques. RESULTS We showed that the OLFJ induced instability accelerated the cartilage degeneration of the contralateral LFJ. Importantly, the SRμCT elucidated that the three-dimensional structure of the subchondral bone changed in contralateral LFJ, indicated as the abnormity of bone volume/total volume ratio (BV/TV), trabecular pattern factor (Tb. Pf), and the trabecular thickness (Tb. Th). Immunostaining further demonstrated the uncoupled osteoclastic bone resorption, and bone formation in the subchondral bone of contralateral LFJ, indicated as increased activity of osteoclast, osteoblast, and Type H vessels. CONCLUSION We develop a novel LFJ OA model demonstrating the effect of abnormal mechanical instability on the degeneration of LFJ. This LFJ degeneration model that highly mimics the clinical conditions is a valuable tool to investigate the LFJ osteoarthritis. LEVEL OF EVIDENCE N/A.
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22
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Zhang N, Tian F, Gou Y, Chen T, Kong Q, Lv Q, Li H, Zhang L. Protective Effect of Alendronate on Lumbar Facet Degeneration in Ovariectomized Rats. Med Sci Monit 2019; 25:4907-4915. [PMID: 31265447 PMCID: PMC6618338 DOI: 10.12659/msm.916978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Facet joint degeneration (FJD) is a potential source of lower back pain, and estrogen deficiency can accelerate FJD. The present study aimed to investigate the effects of alendronate (ALN) on FJD induced by ovariectomy (OVX) in rats. Material/Methods Thirty female Sprague-Dawley rats underwent either bilateral OVX (n=20) or sham surgery (n=10). The OVX rats subsequently received either subcutaneous ALN (70 μg/kg/week) or vehicle for 12 weeks. Subchondral bone mass and microarchitecture were evaluated by micro-computed tomography. Cartilage degradation was evaluated by toluidine blue staining and histological scoring. Results Compared with the Sham group, the OVX group had significantly decreased bone mineral density, bone volume/trabecular volume, and trabecular thickness, significantly increased trabecular separation in subchondral bone, and significantly higher histological score for cartilage degeneration, particularly loss of cartilage thickness. ALN treatment significantly reversed the changes in subchondral bone, preserved cartilage thickness, and reduced the histological score. Immunohistochemical analyses showed significantly decreased expression of ADAMTS-4, MMP-13, and caspase-3 in the OVX+ALN group compared with the OVX group. Conclusions Treatment with ALN suppressed bone loss, subchondral bone architecture deterioration, and cartilage degeneration in OVX rats, which can be explained by roles of ALN in preservation of subchondral bone mass and microarchitecture, and counteraction of catabolism and chondrocyte apoptosis in cartilage.
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Affiliation(s)
- Nan Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Department of Orthopedic Surgery, Kailuan General Hospital, Tangshan, Hebei, China (mainland)
| | - Faming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Yu Gou
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Department of Orthopedic Surgery, Tianjin Hospital, Tianjin, China (mainland)
| | - Tiangang Chen
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Qingfu Kong
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Qinglie Lv
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Hetong Li
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Department of Orthopedic Surgery, Meitan General Hospital, Beijing, China (mainland)
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Chen AS, Miccio VF, Smith CC, Christolias GC, Blanchard AR. Procedural Pain During Lumbar Medial Branch Blocks With and Without Skin Wheal Anesthesia: A Prospective Comparative Observational Study. PAIN MEDICINE 2019; 20:779-783. [DOI: 10.1093/pm/pny322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Allen S Chen
- Department of Orthopedic Surgery, University of California Los Angeles, UCLA Spine Center
| | - Vincent F Miccio
- Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, New York
| | - Clark C Smith
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center
| | - George C Christolias
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center
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Pokorny G, Marchi L, Amaral R, Jensen R, Pimenta L. Lumbar Total Disc Replacement by the Lateral Approach-Up to 10 Years Follow-Up. World Neurosurg 2018; 122:e325-e333. [PMID: 30326312 DOI: 10.1016/j.wneu.2018.10.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to analyze radiologic and clinical results with a minimum 5 years follow-up (FUP) of lateral lumbar total disc replacement for the treatment of symptomatic lumbar degenerative disc disease. METHODS We performed a prospective, single-center, clinical, and radiologic study. Patients were treated with lumbar total disc replacement (extreme lateral total disc replacement) by a lateral transpsoas approach. From 2005 to 2012, 60 patients were enrolled (31 male, 29 female; total, 66 levels; average age, 42.8 years [standard deviation (SD), 9.7 years, range, 22-64 years]; mean body mass index, 26.0 [SD, 3.4]). Clinical end points included visual analog scale and Oswestry Disability Index questionnaires, complications, and reoperation. Radiographic end points included heterotopic ossification (McAfee classification), adjacent level disease, and prosthesis migration or subluxation. RESULTS The mean surgical duration was 122 minutes (SD, 45 minutes) with mean 58 mL (SD, 21 mL) of estimated blood loss. No intraoperative complication occurred. The exceptions were 1 patient with postanesthesia apnea and 2 patients with quadriceps motor deficit (resolved within 4 months with physiotherapy). Of 60 patients, 9 were missed to FUP and 51 (85%) were enrolled in the study, with mean FUP of 92 months (range, 60-122 months). In total, 5 levels (9%; 5 of 55) required to be fused. Both removal of the prostheses and interbody fusion were performed by the lateral transpsoas approach. One patient experienced CrCo allergy (at 2 months); 4 experienced persistent pain from different causes (at 7, 9, 24, and 88 months). Five patients (10%) presented with progression at adjacent levels and 2 (4%) required surgery. One patient required sacroiliac fusion at 63 months. There were no complications during the retrieval surgeries. One partial disc migration occurred but the patient refused retrieval. There was no bone bridging in 9% of the discs (grade 0 heterotopic ossification): grade I, 22%; grade II, 31%; grade III, 20%; grade IV (fusion), 18%. Most heterotopic ossification cases (93%) occurred in the lateral aspect of the disc space, and mostly at the contralateral side of the surgical approach. Patient-reported outcomes significantly improved (P < 0.01) at the last FUP. Visual analog scale back pain score was preoperatively 8.5, early postoperatively 2.5, and at last FUP 3.1. Oswestry Disability Index was preoperatively 55%, early postoperatively 31%, and at last FUP 21%. CONCLUSIONS This study presents mid-term to long-term results of extreme lateral total disc replacement artificial disc for the treatment of lumbar degenerative disease, with fast mobilization, sustained pain relief, and improved physical function. Despite the low rate of ALDis, some discs evolved to ankyloses and others were retrieved. Lumbar artificial disc replacement by the lateral approach seems to be a safe and effective treatment.
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Affiliation(s)
- Gabriel Pokorny
- Instituto de Patologia da Coluna (IPC), São Paulo, São Paulo, Brasil.
| | - Luís Marchi
- Instituto de Patologia da Coluna (IPC), São Paulo, São Paulo, Brasil
| | - Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, São Paulo, Brasil
| | - Rubens Jensen
- Instituto de Patologia da Coluna (IPC), São Paulo, São Paulo, Brasil
| | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo, São Paulo, Brasil; University of California, UCSD, San Diego, California, USA
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Facet joint syndrome: from diagnosis to interventional management. Insights Imaging 2018; 9:773-789. [PMID: 30090998 PMCID: PMC6206372 DOI: 10.1007/s13244-018-0638-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/06/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Abstract Low back pain (LBP) is the most common pain syndrome, and is an enormous burden and cost generator for society. Lumbar facet joints (FJ) constitute a common source of pain, accounting for 15–45% of LBP. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain. History and physical examination may suggest but not confirm facet joint syndrome. Although imaging (radiographs, MRI, CT, SPECT) for back pain syndrome is very commonly performed, there are no effective correlations between clinical symptoms and degenerative spinal changes. Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain. These patients may benefit from specific interventions to eliminate facet joint pain such as neurolysis, by radiofrequency or cryoablation. The purpose of this review is to describe the anatomy, epidemiology, clinical presentation, and radiologic findings of facet joint syndrome. Specific interventional facet joint management will also be described in detail. Teaching points • Lumbar facet joints constitute a common source of pain accounting of 15–45%. • Facet arthrosis is the most frequent form of facet pathology. • There are no effective correlations between clinical symptoms, physical examination and degenerative spinal changes. • Diagnostic positive facet joint block can indicate facet joints as the source of pain. • After selection processing, patients may benefit from facet joint neurolysis, notably by radiofrequency or cryoablation.
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Gómez Vega JC, Acevedo-González JC. Clinical diagnosis scale for pain lumbar of facet origin: systematic review of literature and pilot study. Neurocirugia (Astur) 2018; 30:133-143. [PMID: 29910103 DOI: 10.1016/j.neucir.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/07/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Lumbar pain affects between 60-90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this article is to propose a clinical diagnostic scale for lumbar facet syndrome. MATERIALS AND METHODS The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature was performed regarding the clinical diagnosis of facet-based lumbar pain based on the PRISMA checklist; Phase 2, a list of signs and symptoms proposed for diagnosis lumbar pain of facet origin was made. Phase 3, the list of signs and symptoms found was submitted to a committee of experts to discriminate the most significant signs and symptoms, these were linked to general sociodemographic variables to develop an evaluation questionnaire; Phase 4, the evaluation questionnaire was applied, including those selected signs and symptoms to a group of patients with clinical diagnosis of facet disease lumbar pain and who underwent a selective facet block. Phase 5, under standard technique selective facet block and subsequent postoperative clinical control at 1 month. Phase 6, given pre and postsurgical results associated with signs present in the patients we propose a clinical scale of diagnosis scale. Descriptive statistics and Stata 12.0 were used as statistical software. RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms 1) axial or bilateral axial lumbar pain, 2) improvement with rest, 3) absence of root pattern, may have pseudoradicular pattern, however, the pain is greater lumbar than pain in the leg and 3 clinical signs 1) Kemp sign, 2) pain induced in joint or transverse process, 3) facet stress sign or Acevedo sign. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.
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Affiliation(s)
- Juan Carlos Gómez Vega
- Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Juan Carlos Acevedo-González
- Departamento de Neurociencias, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Coles A, Suri P, Rundell S, Nishio I, Shah L, Standaert C, Friedly J. Radiofrequency Ablation for Facet-Mediated Low Back Pain: Current Knowledge and Limitations of the Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al-Najjim M, Shah R, Rahuma M, Gabbar OA. Lumbar facet joint injection in treating low back pain: Radiofrequency denervation versus SHAM procedure. Systematic review. J Orthop 2017; 15:1-8. [PMID: 29167604 DOI: 10.1016/j.jor.2017.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022] Open
Abstract
The lumbar facet joints have been implicated as one of the causes of low-back pain syndromes. About 15-40% of patients who presented with chronic low-back pain was attributed to lumbar facet joint pain. The purpose of this study was to analyse whether radiofrequency denervation is better than SHAM procedure in treating chronic low-back pain caused by lumbar zygapophysial joints pathology. From the four identified randomised control trials, there is conflicting evidence at an intermediate 3-6-month stage, however; one study demonstrates statistical significance of radiofrequency denervation at 3 months. Longer-term follow-up is needed to prove the efficacy of radiofrequency denervation technique.
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Affiliation(s)
| | - Rohi Shah
- Leicester University Hospital, United Kingdom
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Abstract
Degenerative disease of the spine is a leading cause of back pain and radiculopathy, and is a frequent indication for spine MR imaging. Disc degeneration, disc protrusion/herniation, discarhtrosis, spinal canal stenosis, and facet joint arthrosis, as well as interspinous processes arthrosis, may require an MR imaging workup. This review presents the MR imaging patterns of these diseases and describes the benefit of the MR imaging in these indications compared with the other imaging modalities like plain radiographs or computed tomography scan.
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Radiofrequency thermocoagulation in chronic low back pain from the facet joints: Literature review. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Estrogen deficiency accelerates lumbar facet joints arthritis. Sci Rep 2017; 7:1379. [PMID: 28469263 PMCID: PMC5431109 DOI: 10.1038/s41598-017-01427-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/29/2017] [Indexed: 11/29/2022] Open
Abstract
Dramatic increase in the prevalence of lumbar facet joint (LFJ) arthritis in women around the age of menopause indicates a protective role for estrogen in LFJ arthritis. To date, there is no evidence for this indication and the mechanism of such an effect remains poorly understood. In this study, ovariectomized (OVX) mice were used to mimic the estrogen-deficient status of post-menopausal women. Micro-CT and immunohistochemistry was employed to assess the morphological and molecular changes in ovariectomy-induced LFJ arthritis. The results show that the LFJ subchondral bone mass was significantly decreased in OVX mice, with increased cavities on the interface of the subchondral bone. Severe cartilage degradation was observed in ovariectomy-induced LFJ arthritis. Increased blood vessels and innervations were also found in degenerated LFJ, particularly in the subchondral bone area. 17β-Estradiol treatment efficiently suppressed LFJ subchondral bone turnover, markedly inhibited cartilage degradation, and increased blood vessel and nerve ending growth in degenerated LFJ in OVX mice. Our study reveals that estrogen is a key factor in regulating LFJ metabolism. Severe LFJ degeneration occurs when estrogen is absent in vivo. Collapsed subchondral bone may be the initiation of this process, and estrogen replacement therapy can effectively prevent degeneration of LFJ under estrogen-deficient conditions.
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Hu J, Zhang Y, Duan C, Peng X, Hu P, Lu H. Feasibility study for evaluating early lumbar facet joint degeneration using axial T 1 ρ, T 2 , and T2* mapping in cartilage. J Magn Reson Imaging 2017; 46:468-475. [PMID: 28152249 DOI: 10.1002/jmri.25596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/22/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the feasibility of axial T2 , T2*, and T1 ρ mapping of lumbar facet joint (LFJ) cartilage for evaluation of early degeneration. MATERIALS AND METHODS We examined a total of 176 LFJs from 21 volunteers using axial T2 , T2*, and T1 ρ mapping with a 3.0T magnetic resonance imaging (MRI) scanner. All LFJs were measured and grouped according to the presence of low back pain (LBP), the Weishaupt grading system, and the Pfirrmann grade of the adjacent intervertebral disk (IVD). T2 , T2*, and T1 ρ values were analyzed and compared among the different groups. RESULTS Low interobserver agreement was found in the Weishaupt grading of LFJs (κ = 0.161). The T1 ρ values of LFJs were significantly different between adjacent two Pfirrmann grade of disks (grade I 50.15 ± 3.63 msec / grade II 53.27 ± 3.80 msec, P = 0.002; grade II 53.27 ± 3.80 msec / grade III 58.40 ± 4.17 msec, P < 0.01), and in different Weishaupt grades of LFJs (P = 0.000). T2* values were only found significantly different between Pfirrmann grade I and III of disks (P = 0.048). There was no significant difference in T2 values of LFJs whatever in Pfirrmann (P = 0.556) or Weishaupt grades (P = 0.694). No significant difference was found in T2 , T2*, and T1 ρ values between volunteers with LBP and without LBP (PT2 = 0.783, PT2*=0.311, PT1 ρ = 0.259). CONCLUSION Axial T1 ρ could be an effective and sensitive method to assess for early degenerative changes in LFJ cartilage. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:468-475.
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Affiliation(s)
- Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Yi Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Xianjing Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ping Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hongbin Lu
- Department of Sports Medicine and Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
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Curry WH, Pintar FA, Doan NB, Nguyen HS, Eckardt G, Baisden JL, Maiman DJ, Paskoff GR, Shender BS, Stemper BD. Lumbar spine endplate fractures: Biomechanical evaluation and clinical considerations through experimental induction of injury. J Orthop Res 2016; 34:1084-91. [PMID: 26610067 DOI: 10.1002/jor.23112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/25/2015] [Indexed: 02/04/2023]
Abstract
Lumbar endplate fractures were investigated in different experimental scenarios, however the biomechanical effect of segmental alignment was not outlined. The objectives of this study were to quantify effects of spinal orientation on lumbar spine injuries during single-cycle compressive loads and understand lumbar spine endplate injury tolerance. Twenty lumbar motion segments were compressed to failure. Two methods were used in the preparation of the lumbar motion segments. Group 1 (n = 7) preparation maintained pre-test sagittal lordosis, whereas Group 2 (n = 13) specimens had a free-rotational end condition for the cranial vertebra, allowing sagittal rotation of the cranial vertebra to create parallel endplates. Five Group 1 specimens experienced posterior vertebral body fracture prior to endplate fracture, whereas two sustained endplate fracture only. Group 2 specimens sustained isolated endplate fractures. Group 2 fractures occurred at approximately 41% of the axial force required for Group 1 fracture (p < 0.05). Imaging and specimen dissection indicate endplate injury consistently took place within the confines of the endplate boundaries, away from the vertebral periphery. These findings indicate that spinal alignment during compressive loading influences the resulting injury pattern. This investigation identified the specific mechanical conditions under which an endplate breach will take place. Development of endplate injuries has significant clinical implication as previous research identified internal disc disruption (IDD) and degenerative disc disease (DDD) as long-term consequences of the axial load-shift that occurs following a breach of the endplate. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1084-1091, 2016.
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Affiliation(s)
- William H Curry
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Frank A Pintar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Ninh B Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gerald Eckardt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis J Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Glenn R Paskoff
- Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland
| | - Barry S Shender
- Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland
| | - Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
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Kim JS, Ali MH, Wydra F, Li X, Hamilton JL, An HS, Cs-Szabo G, Andrews S, Moric M, Xiao G, Wang JHC, Chen D, Cavanaugh JM, Im HJ. Characterization of degenerative human facet joints and facet joint capsular tissues. Osteoarthritis Cartilage 2015; 23:2242-2251. [PMID: 26117175 PMCID: PMC4663154 DOI: 10.1016/j.joca.2015.06.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 05/27/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lumbar facet joint degeneration (FJD) may be an important cause of low back pain (LBP) and sciatica. The goal of this study was to characterize cellular alterations of inflammatory factor expression and neovascularization in human degenerative facet joint capsular (FJC) tissue. These alterations in FJC tissues in pain stimulation were also assessed. DESIGN FJs were obtained from consented patients undergoing spinal reconstruction surgery and cadaveric donors with no history of back pain. Histological analyses of the FJs were performed. Cytokine antibody array and quantitative real-time polymerase chain reaction (qPCR) were used to determine the production of inflammatory cytokines, and western blotting analyses (WB) were used to assay for cartilage-degrading enzymes and pain mediators. Ex vivo rat dorsal root ganglion (DRG) co-culture with human FJC tissues was also performed. RESULTS Increased neovascularization, inflammatory cell infiltration, and pain-related axonal-promoting factors were observed in degenerative FJCs surgically obtained from symptomatic subjects. Increased VEGF, (NGF/TrkA), and sensory neuronal distribution were also detected in degenerative FJC tissues from subjects with LBP. qPCR and WB results demonstrated highly upregulated inflammatory cytokines, pain mediators, and cartilage-degrading enzymes in degenerative FJCs. Results from ex vivo co-culture of the DRG and FJC tissue demonstrated that degenerative FJCs increased the expression of inflammatory pain molecules in the sensory neurons. CONCLUSION Degenerative FJCs possess greatly increased inflammatory and angiogenic features, suggesting that these factors play an important role in the progression of FJD and serve as a link between joint degeneration and neurological stimulation of afferent pain fibers.
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Affiliation(s)
- Jae-Sung Kim
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,The Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, 501-759, Republic of Korea
| | - Mir H. Ali
- Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Frank Wydra
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Xin Li
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - John L. Hamilton
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Howard S. An
- Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Gabriella Cs-Szabo
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Mario Moric
- Department of Anesthesiology, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - Guozhi Xiao
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Biology and Shenzhen Key Laboratory of Cell Microenvironment, South University of Science and Technology of China, Shenzhen, 518055, China
| | - James H-C Wang
- MechanoBiology Laboratory Departments of Orthopaedic Surgery, Bioengineering, and Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Di Chen
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA
| | - John M. Cavanaugh
- Bioengineering Center, Wayne State University, Detroit, MI 48202, USA
| | - Hee-Jeong Im
- Department of Biochemistry, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Orthopedic Surgery, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Internal Medicine, Section of Rheumatology, Rush University at Rush University Medical Center, Chicago, IL 60612, USA,Department of Bioengineering, University of Illinois, Chicago, IL 60612, USA,Jesse Brown Veterans Affair, Chicago IL 60612, USA,Address correspondence to: Dr. Hee-Jeong Im Sampen, Rush University Medical Center, Cohn Research BD 516, 1735 W. Harrison St., Chicago, IL 60612, Tel: 312-942-3091, Fax: 312-942-3053,
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Loh JT, Nicol AL, Elashoff D, Ferrante FM. Efficacy of needle-placement technique in radiofrequency ablation for treatment of lumbar facet arthropathy. J Pain Res 2015; 8:687-94. [PMID: 26504407 PMCID: PMC4605254 DOI: 10.2147/jpr.s84913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Many studies have assessed the efficacy of radiofrequency ablation to denervate the facet joint as an interventional means of treating axial low-back pain. In these studies, varying procedural techniques were utilized to ablate the nerves that innervate the facet joints. To date, no comparison studies have been performed to suggest superiority of one technique or even compare the prevalence of side effects and complications. Materials and methods A retrospective chart review was performed on patients who underwent a lumbar facet denervation procedure. Each patient’s chart was analyzed for treatment technique (early versus advanced Australian), preprocedural visual numeric scale (VNS) score, postprocedural VNS score, duration of pain relief, and complications. Results Pre- and postprocedural VNS scores and change in VNS score between the two groups showed no significant differences. Patient-reported benefit and duration of relief was greater in the advanced Australian technique group (P=0.012 and 0.022, respectively). The advanced Australian technique group demonstrated a significantly greater median duration of relief (4 months versus 1.5 months, P=0.022). Male sex and no pain-medication use at baseline were associated with decreased postablation VNS scores, while increasing age and higher preablation VNS scores were associated with increased postablation VNS scores. Despite increasing age being associated with increased postablation VNS scores, age and the advanced Australian technique were found to confer greater patient self-reported treatment benefit. Conclusion The advanced Australian technique provides a significant benefit over the early Australian technique for the treatment of lumbar facet pain, both in magnitude and duration of pain relief.
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Affiliation(s)
- Jeffrey T Loh
- Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea L Nicol
- Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Department of Biomathematics, University of California Los Angeles, Los Angeles, CA, USA
| | - F Michael Ferrante
- Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Little JW, Grieve TJ, Cramer GD, Rich JA, Laptook EE, Stiefel JPD, Linaker K. Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study. J Manipulative Physiol Ther 2015; 38:344-51. [PMID: 26118786 DOI: 10.1016/j.jmpt.2014.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. METHODS Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets). RESULTS Using the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54). CONCLUSIONS The modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.
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Affiliation(s)
- Joshua W Little
- Assistant Professor, Center for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - Thomas J Grieve
- Instructor, Department of Clinical Sciences, National University of Health Sciences, Lombard, IL
| | - Gregory D Cramer
- Professor and Dean of Research, Research Department, National University of Health Sciences, Lombard, IL.
| | - Jeffrey A Rich
- Radiologist, Northwestern Health Sciences University, Bloomington, MN
| | - Evelyn E Laptook
- Assistant Professor, National University of Health Sciences, Lombard, IL
| | | | - Kathleen Linaker
- Dean, Center for Life and Health Sciences, Mohawk Valley Community College, Utica, NY
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Articular dysfunction patterns in patients with mechanical low back pain: A clinical algorithm to guide specific mobilization and manipulation techniques. ACTA ACUST UNITED AC 2015; 20:499-502. [DOI: 10.1016/j.math.2014.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/21/2014] [Accepted: 11/12/2014] [Indexed: 11/19/2022]
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Not All Conditions Respond Equally to Spine Injections: A Review of the Outcome Literature for Common Spine Pathologies. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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40
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Abstract
OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men) diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone allograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.
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Sethi R, Singh V, Chauhan B, Thukral B. Prevalence of facet joint arthrosis in lumbago patients–CT scan evaluation. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ko S, Vaccaro AR, Lee S, Lee J, Chang H. The prevalence of lumbar spine facet joint osteoarthritis and its association with low back pain in selected Korean populations. Clin Orthop Surg 2014; 6:385-91. [PMID: 25436061 PMCID: PMC4233216 DOI: 10.4055/cios.2014.6.4.385] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/15/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study was to evaluate the association of lumbar spine facet joint osteoarthritis (LSFJOA) identified by multi-detector computed tomography (MDCT) with age and low back pain (LBP) in an adult community-based population in Korea. METHODS A sample of 472 participants (age range, 20 to 84 years) who underwent MDCT imaging for abdominal or urological lesions, not for chief complaints of LBP, were included in this study. LSFJOA based on MDCT findings was characterized using four grades of osteoarthritis of the facet joints. The prevalence of LSFJOA according to age group (below 40 years, 40-49 years, 50-59 years, 60-69 years, and above 70 years), gender, and spinal level was analyzed using chi-square tests and the association between LBP and LSFJOA adjusting for age, gender, and spine level was analyzed using multiple binary logistic regression test. RESULTS Eighty-three study subjects (17.58%) had LSFJOA (grade ≥ 2). The prevalence of LSFJOA was not associated with gender (p = 0.092). The prevalence of LSFJOA increased with age (p = 0.015). The highest prevalence of LSFJOA was observed at L4-5 in men (p = 0.001) and at L5-S1 in women (p = 0.003), and at L5-S1 in the overall population (p = 0.000). LSFJOA was not associated with LBP in men (p = 0.093) but was associated with LBP in women (p = 0.003), especially at L3-4 (p = 0.018) and L5-S1 (p = 0.026). CONCLUSIONS The prevalence of LSFJOA based on the computed tomography imaging was 17.58% in the adult community Korean population. The prevalence of LSFJOA increased with age, and the highest prevalence was noted at L5-S1. LSFJOA was not associated with LBP at any spinal level and age except at L3-4 and L5-S1 in women.
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Affiliation(s)
- Sangbong Ko
- Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sangwook Lee
- Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jaekun Lee
- Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hojin Chang
- Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
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Andrés Chahín F, Carlos Valenzuela C. Evaluación y manejo del dolor lumbar de origen facetario. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rocha IDD, Cristante AF, Marcon RM, Oliveira RP, Letaif OB, Barros Filho TEPD. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics (Sao Paulo) 2014; 69:529-34. [PMID: 25141111 PMCID: PMC4129553 DOI: 10.6061/clinics/2014(08)05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/24/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05). CONCLUSION Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.
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Affiliation(s)
- Ivan Dias da Rocha
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
| | - Alexandre Fogaça Cristante
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
| | - Raphael Martus Marcon
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
| | - Reginaldo Perilo Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
| | - Olavo Biraghi Letaif
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
| | - Tarcisio Eloy Pessoa de Barros Filho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Spine Surgery Division, São Paulo, SP, Brazil
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Pangarkar S, Miedema ML. Pulsed Versus Conventional Radio Frequency Ablation for Lumbar Facet Joint Dysfunction. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-013-0040-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dykstra DD, Stuckey MW, Schimpff SN, Singh JA, Mahowald ML. The effects of intra-articular botulinum toxin on sacroiliac, cervical/lumbar facet and sterno-clavicular joint pain and C-2 root and lumbar disc pain: a case series of 11 patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/016911107x217473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Annaswamy TM, Bierner SM, Doppalapudi H. Does lumbar dorsal ramus syndrome have an objective clinical basis? PM R 2013; 5:996-1006. [PMID: 23994120 DOI: 10.1016/j.pmrj.2013.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Degenerative processes can cause chronic low back pain that occasionally creates impingement of the lumbar dorsal rami, resulting in a clinical syndrome previously described as lumbar dorsal ramus syndrome (LDRS). OBJECTIVES To evaluate the clinical basis of LDRS by comparing pain, disability, and objective measures of pathophysiology in 3 groups of subjects defined by needle electromyography examination (NEE) findings. DESIGN Prospective group cohort study with retrospective chart review. SETTING Veterans Affairs medical center outpatient clinic. PATIENTS Subjects who had undergone lower limb NEE and lumbar magnetic resonance imaging. METHODS A total of 71 subjects' records that met the study criteria were retrospectively reviewed for interventional spine procedures performed and to measure the lumbosacral paraspinal cross-sectional area (PSP CSA); 28 of the 71 subjects underwent further clinical assessment. One-way analysis of variance was performed to evaluate group differences. MAIN OUTCOME MEASUREMENTS In the retrospective arm: (1) PSP CSAs measured at 4 lower lumbar disk levels (average of 3 consecutive slices/level) bilaterally and overall left and right lumbar average PSP CSA and (2) the frequency and type of interventional spine procedures performed. In the prospective arm: (1) temporal changes of NEE abnormalities, (2) pain measured using the Visual Analog Scale, (3) Pain Disability Questionnaire responses, and (4) Short Form-36 scores. RESULTS The right L5 CSA was significantly greater in the group with mechanical low back pain compared with the group with lumbar radicular syndrome (F = 3.3; P < .05). No significant group differences were noted in the number of spine procedures performed. No significant differences in pain or disability scores were found among the groups. NEE findings improved over time predominantly in the LDRS group. CONCLUSIONS LDRS is a diagnosis with identifiable NEE (lumbar multifidus denervation) findings and magnetic resonance imaging findings that may include lower lumbar paraspinal atrophy. NEE (paraspinal denervation) findings in persons with LDRS may change over time, and the clinical relevance of LDRS to pain, functional disability, and treatment response is unclear.
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Affiliation(s)
- Thiru M Annaswamy
- Electrodiagnostic and Spine Sections, PM&R Service, Dallas VA Medical Center, 4500 S Lancaster Rd, Dallas, TX 75216; and Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX(∗).
| | - Samuel M Bierner
- Department of PM&R and PM&R Residency Program, UT Southwestern Medical Center, Dallas, TX(†)
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Sodha R, Sivanadarajah N, Alam M. The use of glucosamine for chronic low back pain: a systematic review of randomised control trials. BMJ Open 2013; 3:bmjopen-2012-001167. [PMID: 23794557 PMCID: PMC3686234 DOI: 10.1136/bmjopen-2012-001167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To ascertain whether the use of oral glucosamine influences symptoms or functional outcomes in patients with chronic low back pain (LBP) thought to be related to spinal osteoarthritis (OA). DESIGN Systematic review of randomised control trials. Searches were performed up to March 2011 on Medline, AMED, CINHAL, Cochrane and EMBASE with subsequent reference screening of retrieved studies. In addition, the grey literature was searched via opensigle. Included studies were required to incorporate at least one of the Cochrane Back Pain Review Group's outcome measures as part of their design. Trials with participants over 18 years with a minimum of 12 weeks of back pain, in combination with radiographic changes of OA in the spine, were included. Studies were rated for risk-of-bias and graded for quality. RESULTS 148 studies were identified after screening and meeting eligibility requirements, and three randomised controlled trials (n=309) were included in the quantitative synthesis. The review found that there was low quality but generally no evidence of an effect from glucosamine on function, with no change in the Roland-Morris Disability Questionnaire score in all studies. Conflicting evidence was demonstrated with pain scores with two studies showing no difference and one study with a high risk-of-bias showing both a statistically and clinically significant improvement from taking glucosamine. CONCLUSIONS On the basis of the current research, any clinical benefit of oral glucosamine for patients with chronic LBP and radiographic changes of spinal OA can neither be demonstrated nor excluded based on insufficient data and the low quality of existing studies.
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Affiliation(s)
- Reena Sodha
- East of England Deanery
- Department of Health Sciences, University of East Anglia, Norwich, UK
| | - Naveethan Sivanadarajah
- Department of Trauma & Orthopaedics, Royal National Orthopaedic Hospital, London, UK
- John Scales Centre for Biomedical Engineering, University College London
| | - Mahbub Alam
- Department of Trauma & Orthopaedics, Royal National Orthopaedic Hospital, London, UK
- Department of Mechanical Engineering, Imperial College London, London, UK
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Chambers H. Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 2013; 11:106-20. [PMID: 23468052 DOI: 10.1002/msc.1045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to summarize the available evidence on lumbar facet joint injections and the physiotherapy treatments, land-based lower back mobility exercise, soft tissue massage and lumbar spinal mobilizations for chronic low back pain (CLBP). The plausibility of physiotherapy and lumbar facet joint injections as a combination treatment is discussed. METHODS Using a systematic process, an online electronic search was performed using key words utilizing all available databases and hand searching reference lists. Using a critical appraisal tool from the Critical Appraisal Skills Programme (CASP), the literature was screened to include primary research. The main aspects of the research were summarized. RESULTS The evidence for lumbar facet joint injections suggests an overall short-term positive effect on CLBP. Land-based lower back mobility exercise and soft tissue massage appear to have a positive effect on CLBP in the short term and possibly in the longer term. There is insufficient evidence to draw conclusions for lumbar spinal mobilizations. CONCLUSION The review indicates that lumbar facet joint injections create a short period when pain is reduced. Physiotherapy treatments including land-based lower back mobility exercise and soft tissue massage may be of benefit during this time to improve the longer-term outcomes of patients with CLBP. It is not possible to make generalizations or firm conclusions. The current review highlights the need for further research. A randomized controlled trial is recommended to assess the impact of physiotherapy in combination with lumbar facet joint injections on CLBP.
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Derby R, Melnik I, Lee JE, Lee SH. Cost comparisons of various diagnostic medial branch block protocols and medial branch neurotomy in a private practice setting. PAIN MEDICINE 2013; 14:378-91. [PMID: 23294522 DOI: 10.1111/pme.12026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We calculated the average total facility and professional cost of medial branch neurotomy (MBN) procedure and diagnostic medial branch blocks (MBBs), based on increments of MBB results (50-100% cutoff values), to determine the most cost-effective protocol that correlates with positive MBN outcome. DESIGN/METHODS We evaluated both actual cost and the theoretical cost of procedures in three groups: 0, single and double MBB. We calculated costs assuming MBB success rates at incrementally higher levels by incrementally raising the cutoff values for a successful diagnostic MBB by 10% increments (from 50% to 100%). We analyzed each cutoff value using the preposition that all patients meeting the cutoff value would proceed to MBN. Those not meeting the cutoff value would not have the cost of MBN added to the cost calculations. A cost per successful procedure was also analyzed. RESULTS Cost savings were noted when ≥70% cutoff MBB values were utilized and additionally when patients declined MBN for reasons other than their MBB outcome, although these dropouts lowered the cost-effectiveness of MBB when analyzed as cost per successful procedure. Costs over 5 years per successful procedure using 0, 1 and 2 diagnostic MBB protocol (x) and MBB protocol (o) were, however, similar at all MBB cutoff values. CONCLUSIONS Diagnostic MBB using progressively stringent MBB cutoff values incrementally excluded patients without posterior element pain as evidenced by incremental increase in positive outcomes following MBN. The exclusion of patients from MBN due to failure to report 70% or greater pain relief following MBB resulted in cost savings in favor of performing diagnostic MBB.
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Affiliation(s)
- Richard Derby
- Spinal Diagnostics and Treatment Center, Daly City, CA 94015, USA.
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