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Cocconi F, Maffulli N, Bell A, Memminger MK, Simeone F, Migliorini F. Sacroiliac joint pain: what treatment and when. Expert Rev Neurother 2024:1-8. [PMID: 39262128 DOI: 10.1080/14737175.2024.2400682] [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: 06/30/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Spinal and non-spinal pathologies can cause low back pain. Non-spinal sources of low back pain include the sacroiliac joint (SIJ) and the hip. SIJ pain can be treated either conservatively or surgically. Current strategies for managing sacroiliac joint pain are debated, and limited evidence exists. AREAS COVERED The present expert opinion updates current evidence on conservative and surgical modalities for SIJ pain. EXPERT OPINION Surgical management for SIJ pain is effective. However, it exposes patients to surgery and, therefore, related complications. Conservative management may be implemented in patients with moderate SIJ pain, with less than six months of symptoms, or not eligible for surgery. Several noninvasive modalities are available, mostly centered on intra-articular injections. Corticosteroids, platelet-rich plasma, and stem cells have only midterm lasting effects, at most for nine months. Radiofrequency ablation is another methodology for pain relief. Both continuous and pulsatile radiofrequency ablation are associated with good outcomes. SIJ fusion can be performed using different techniques; however, a clear recommendation on the most appropriate modality for the management of SIJ pain is still debated.
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Affiliation(s)
- Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Medicine and Psychology, University La Sapienza, Roma, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Michael Kurt Memminger
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy
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Lenz M, Egenolf P, Menzhausen J, Heck V, Perera A, Eysel P, Scheyerer M, Oikonomidis S. Clinical Outcome after Endoscopic Facet Denervation in Patients with Chronic Low Back Pain. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 39187240 DOI: 10.1055/a-2348-1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Several studies have reported that low back pain has a high prevalence among the population, with up to 85%. Percutaneous radiofrequency facet denervation (PRFD) is the gold standard of today's rhizotomy for chronic low back pain (CLBP). However, previously published studies present controversial results for the efficacy of PRFD. Therefore, this study aimed to analyse the use of endoscopic facet joint denervation (EFJD) to treat chronic low back pain and to identify potential risk factors that could limit indications for surgery.We retrospectively included 31 eligible patients into the study with at least 24 months of CLBP. All patients underwent EFJD and had to complete ODI, COMI, EQ-5D and VRS scores postoperatively, with a minimum follow up of 12 months. Basic patient data was recorded to analyse correlations.We found a significant improvement in all clinical scores measured, such as ODI, COMI, EQ-5D and VRS scores. While the best result was found at the 3 months follow-up, a slight deterioration was found at 12 months follow-up. However, significant benefit was observed when compared to preoperative scores. 28/31 patients (93.3%) reported reduced pain at 12 months follow-up and were satisfied with the procedure. Older age and psychiatric precondition were identified as potential risk factors associated with poorer outcome. Postoperative complications such as haematoma, a sensibility disorder and temporary low extremity muscular weakness were rarely observed.EFJD showed significant improvement of the clinical outcome scores and VRS when compared to preoperative results of patients, with a minimum of 12 months of CLBP prior to surgery. Older patients and patients with a psychiatric precondition seem to benefit less from the procedure.
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Affiliation(s)
- Maximilian Lenz
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Philipp Egenolf
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Johanna Menzhausen
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Vincent Heck
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Akanksha Perera
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Peer Eysel
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Max Scheyerer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Duesseldorf, Düsseldorf, Deutschland
| | - Stavros Oikonomidis
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
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Qi LN, Sun Y, Shi YT, Yang JH, Yang YR, Qin XZ. Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. Curr Pain Headache Rep 2024; 28:699-708. [PMID: 38526650 DOI: 10.1007/s11916-024-01241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. RECENT FINDINGS There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.
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Affiliation(s)
- Ling Na Qi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Ye Sun
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yu Tong Shi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Jing Han Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yi Ran Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Xiang Zheng Qin
- Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
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Liu Z, Chen J, Fang D, Xu Y, Zhou X, Zheng Z, Zhang Z, Fan C, Luo S, Liu Z, Li Q, Zhao Q. Anatomical Observation and Clinical Significance of the Medial Branch of the Lumbar Dorsal Rami. Spine (Phila Pa 1976) 2024; 49:E164-E172. [PMID: 38420729 DOI: 10.1097/brs.0000000000004975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
STUDY DESIGN Anatomical study. OBJECTIVE This study aimed to elaborate on the anatomical characteristics of the medial branch of the lumbar dorsal rami and to discuss its possible clinical significance. SUMMARY OF BACKGROUND DATA Radiofrequency ablation targeting the medial branch of the lumbar dorsal rami has been increasingly used in the clinical management of facetogenic low back pain (FLBP). Nonetheless, attention is also being given to complications such as atrophy of the lumbar soft tissues and muscles. Therefore, a more detailed understanding of the innervation pattern on the facet joint may improve the precision of nerve ablation therapy for FLBP. METHODS An anatomical study of eight human specimens was carried out. The anatomic characteristics of the medial branch were observed and recorded. RESULTS The medial branch originates from the lumbar dorsal rami, running close to the root of the posterolateral side of the superior articular process of the inferior cone. When passed through the mamillo-accessory ligament, it turns direction to the medial and caudal side, running in the multifidus muscle. In our study, each medial branch sent out two to five branches along the way. All the medial branches in L1-L4 gave off one to two small branches when crossing the facet joint and innervated the joint of the lower segment. Nineteen medial branches (23.75%) gave off recurrent branches to innervate the joint at the upper segment. CONCLUSION The anatomical features of the medial branch remain similar in each lumbar segment. There are two types of joint branches, including the articular fibers that emanate from the medial branch as it runs along the medial border of the facet joint and the recurrent branch from the medial branch that innervates the upper facet joint. Moreover, an anastomotic branch was found in the medial branches between different segments.
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Affiliation(s)
- Zexian Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Junjie Chen
- The Spine Department, Orthopaedic Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Duopei Fang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yejie Xu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyang Zheng
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chaohui Fan
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shiwen Luo
- Department of Anatomy, School of the Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zezheng Liu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Du R, Gao J, Wang B, Zhang J, Meng M, Wang J, Qu W, Li Z. Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:463-473. [PMID: 38141106 DOI: 10.1007/s00586-023-08078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy. METHODS We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software. RESULTS A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1 year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = -0.87, 95% confidence interval (CI) [-2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = -0.13, 95%CI [-0.18, -0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0 .0001). CONCLUSION The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jing Gao
- Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Bo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Meng Meng
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Jingzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Wentao Qu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 5 Longbin Road, Development Zone, Dalian, 116011, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, Liaoning, People's Republic of China.
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Lewandrowski KU, Yeung A, Lorio MP, Yang H, Ramírez León JF, Sánchez JAS, Fiorelli RKA, Lim KT, Moyano J, Dowling Á, Sea Aramayo JM, Park JY, Kim HS, Zeng J, Meng B, Gómez FA, Ramirez C, De Carvalho PST, Rodriguez Garcia M, Garcia A, Martínez EE, Gómez Silva IM, Valerio Pascua JE, Duchén Rodríguez LM, Meves R, Menezes CM, Carelli LE, Cristante AF, Amaral R, de Sa Carneiro G, Defino H, Yamamoto V, Kateb B. Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis. J Pers Med 2023; 13:jpm13050710. [PMID: 37240880 DOI: 10.3390/jpm13050710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
- Department of Orthopedics at Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, R. Mariz e Barros, 775-Maracanã, Rio de Janeiro 20270-004, Brazil
- Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA
| | - Anthony Yeung
- Desert Institute for Spine Care, 1635 E Myrtle Ave Suite 400, Phoenix, AZ 85020, USA
- Department of Neurosurgery, University of New Mexico School of Medicine, 915 Camino de Salud NE Albuquerque, Albuquerque, NM 87106, USA
| | - Morgan P Lorio
- Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China
| | - Jorge Felipe Ramírez León
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Bogotá 110141, Colombia
| | | | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20000-000, Brazil
| | - Kang Taek Lim
- Good Doctor Teun Teun Spine Hospital, Seoul 775 , Republic of Korea
| | - Jaime Moyano
- Torres Médicas Hospital Metropolitano, San Gabriel y Nicolás Arteta Torre Médica 3, Piso 5, Quito 170521, Ecuador
| | - Álvaro Dowling
- DWS Spine Clinic Center, CENTRO EL ALBA-Cam. El Alba 9500, Of. A402, Región Metropolitana, Las Condes 9550000, Chile
- Department of Orthopaedic Surgery, Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), Ribeirão Preto 14040-900, Brazil
| | | | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 731, Republic of Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam Hospital, Seoul 731, Republic of Korea
| | - Jiancheng Zeng
- Department of Orthopaedic Surgery, West China Hospital Sichuan University, Chengdu 610041, China
| | - Bin Meng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215005, China
| | | | - Carolina Ramirez
- Centro de Cirugía Mínima Invasiva-CECIMIN, Avenida Carrera 45 # 104-76, Bogotá 0819, Colombia
| | - Paulo Sérgio Teixeira De Carvalho
- Department of Neurosurgery, Pain and Spine Minimally Invasive Surgery Service at Gaffree Guinle University Hospital, Rio de Janeiro 20270-004, Brazil
| | - Manuel Rodriguez Garcia
- Spine Clinic, The American-Bitish Cowdray Medical Center I.A.P, Campus Santa Fe, Mexico City 05370, Mexico
| | - Alfonso Garcia
- Department of Orthopaedic Surgery, Espalda Saludable, Hospital Angeles Tijuana, Tijuana 22010, Mexico
| | - Eulalio Elizalde Martínez
- Department of Spine Surgery, Hospital de Ortopedia, UMAE "Dr. Victorio de la Fuente Narvaez", Ciudad de México 07760, Mexico
| | - Iliana Margarita Gómez Silva
- Department of Spine Surgery, Hospital Ángeles Universidad, Av Universidad 1080, Col Xoco, Del Benito Juárez, Ciudad de México 03339, Mexico
| | | | - Luis Miguel Duchén Rodríguez
- Center for Neurological Diseases, Bolivian Spine Association, Spine Chapter of Latin American Federation of Neurosurgery Societies, Public University of El Alto, La Paz 0201-0220, Bolivia
| | - Robert Meves
- Santa Casa Spine Center, São Paulo 09015-000, Brazil
| | - Cristiano M Menezes
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil
| | | | | | - Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), São Paulo 14040-900, Brazil
| | | | - Helton Defino
- Hospital das Clínicas of Ribeirao Preto Medical School, Sao Paulo University, Ribeirão Preto 14040-900, Brazil
| | - Vicky Yamamoto
- Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA
- The USC Caruso Department of Otolaryngology-Head and Neck Surgery, USC Keck School of Medicine, Los Angeles, CA 90033, USA
- USC-Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
- World Brain Mapping Foundation (WBMF), Pacific Palisades, CA 90272, USA
| | - Babak Kateb
- Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA
- World Brain Mapping Foundation (WBMF), Pacific Palisades, CA 90272, USA
- Society for Brain Mapping and Therapeutics (SBMT), Pacific Palisades, CA 90272, USA
- National Center for Nano Bio Electronic (NCNBE), Los Angeles, CA 90272, USA
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Bernardes ALPR, Correa RF, Trajano LADSN, Fontes IA. Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review. Rev Bras Ortop 2023; 58:199-205. [PMID: 37252302 PMCID: PMC10212637 DOI: 10.1055/s-0043-1768695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 05/31/2023] Open
Abstract
Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.
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Chen KT, Kim JS, Huang APH, Lin MHC, Chen CM. Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion. Neurospine 2023; 20:33-42. [PMID: 37016852 PMCID: PMC10080449 DOI: 10.14245/ns.2346190.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
Endoscopic spine surgery (ESS) has evolved as a safe, effective, and efficient alternative for minimally invasive spine surgery (MISS). The innovation of full-endoscopic systems makes definitive decompression surgery through different approaches feasible. The approach can be determined according to the location of the target lesion or the surgeon's preference. During the past 2 decades, ESS has expanded its indications from lumbar to cervical spines. Except for decompression, endoscopy-assisted fusion surgery is also developing. However, ESS is still evolving and has a steep learning curve. The revolution of technologies and ESS techniques will enable surgeons to treat various spinal diseases more practically. In recent years, the application of the computer-assisted navigation system and augmented reality have reformed imaging quality and interpretation. The endoscopic rhizotomy techniques have opened a new way for MISS of chronic low back pain. This review introduces the current indications of ESS and its potential future expansion.
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Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Chien-Min Chen
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Corresponding Author Chien-Min Chen Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County 500, Taiwan
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Endoscopic Rhizotomy for Facetogenic Back Pain: A Review of the History, Financial Considerations, Patient Selection Criteria, and Clinical Outcomes. World Neurosurg 2023; 169:36-41. [PMID: 36220495 DOI: 10.1016/j.wneu.2022.10.020] [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: 08/03/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic back pain (CBP) is a condition that places a considerable burden on society, with several million people affected in the United States alone. Treatment options to address this problem and relieve CBP are constantly evolving, and one of the most promising treatment modalities for CBP that is refractory to conservative treatment options is endoscopic rhizotomy (ER). METHODS A thorough search of the PubMed (MEDLINE) database was conducted to assess the full progression of ER from its earliest uses to present day in a historical narrative review of ER, with treatment of facetogenic pain as a model pathology. RESULTS ER allows for direct visualization and ablation of sensory branches of the dorsal ramus to provide pain relief in up to 80% of patients faced with refractory CBP. This technique has been built upon since the early 20th century, and the novel endoscopic approach continues to gain popularity among physicians. Benefits of ER include superior postoperative median pain-free duration compared with traditional percutaneous radiofrequency ablation, as well as direct visualization of regional anatomy. Patient selection criteria for the procedure and a modest list of contraindications allow the use of ER as a viable treatment option for a significant population of patients suffering from CBP. Potential barriers to ER include high cost of the procedure, longer intraoperative time, and expensive proprietary equipment. CONCLUSIONS ER is an effective treatment for refractory CBP with notable advantages. As the technology and popularity of this procedure progress, improvements in the cost, training, and intraoperative time may make it a favorable alternative to the current standard of care.
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Burton C, Ehsanian R, Capra J, Rivers WE, Shin P. Endoscopic transection of right L3 and L4 medial branch nerves and L5 dorsal ramus: A 2-dimensional operative video. INTERVENTIONAL PAIN MEDICINE 2022; 1:100142. [PMID: 39238873 PMCID: PMC11373044 DOI: 10.1016/j.inpm.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 09/07/2024]
Affiliation(s)
- Chris Burton
- University of New Mexico School of Medicine, USA
| | | | | | - W Evan Rivers
- Tennessee Valley Healthcare System, Veterans Administration, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, USA
| | - Peter Shin
- University of New Mexico School of Medicine, USA
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Du R, Xu G, Bai X, Li Z. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. J Pain Res 2022; 15:3689-3710. [PMID: 36474960 PMCID: PMC9719706 DOI: 10.2147/jpr.s389602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/16/2023] Open
Abstract
Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Gang Xu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
| | - Xujue Bai
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
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Li H, An J, Zhang J, Kong W, Yun Z, Yu T, Nie X, Liu Q. Comparative efficacy of radiofrequency denervation in chronic low back pain: A systematic review and network meta-analysis. Front Surg 2022; 9:899538. [PMID: 35990102 PMCID: PMC9388860 DOI: 10.3389/fsurg.2022.899538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Facet joint pain is a common cause of chronic low back pain (CLBP). Radiofrequency (RF) denervation is an effective treatment option. Purpose A systematic review and network meta-analysis (NMA) was performed to evaluate and compare the efficacy and effectiveness of different RF denervation treatments in managing facet joint-derived CLBP. Methods The Cochrane Library, Embase, PubMed, and China Biology Medicine were searched to identify eligible randomized controlled trials (RCTs) from January 1966 through December 2021. Interventions included conventional radiofrequency denervation (CRF), pulsed radiofrequency denervation (PRF), pulsed radiofrequency treatment of the dorsal root ganglia (PRF-DRG), radiofrequency facet capsule denervation (RF-FC), and radiofrequency ablation under endoscopic guidance (ERFA). The outcome was the mean change in visual analog scale (VAS) score from baseline. A random-effects NMA was used to compare the pain relief effects of the interventions over the short term (≤6 months) and long term (12 months). The rank of effect estimation for each intervention was computed using the surface under the cumulative ranking curve. Results A total of 10 RCTs with 715 patients met the inclusion criteria. Moderate evidence indicated that CRF denervation had a greater effect on pain relief than sham control in the short term (standardized mean difference (SMD) −1.58, 95% confidence intervals (CI) −2.98 to −0.18) and the long term (SMD −4.90, 95% CI, −5.86 to −3.94). Fair evidence indicated that PRF denervation was more effective than sham control for pain over the long term (SMD −1.30, 95% CI, −2.17 to −0.43). Fair evidence showed that ERFA denervation was more effective for pain relief than sham control in the short term (SMD −3.07, 95% CI, −5.81 to −0.32) and the long term (SMD −4.00, 95% CI, −4.95 to −3.05). Fair evidence showed that RF-FC denervation was more effective for pain relief than sham control in the long term (SMD −1.11, 95% CI, −2.07 to −0.15). A fair level of evidence indicated that PRF-DRG denervation was more effective for pain relief than sham control in the short term (SMD −5.34, 95% CI, −8.30 to −2.39). Conclusion RF is an effective option for patients diagnosed with facet joint-derived CLBP. Systematic Review Registration: Identifier: CRD42022298238.
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Affiliation(s)
- Han Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Junyan An
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jun Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Weijian Kong
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhihe Yun
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tong Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xinyu Nie
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Correspondence: Qinyi Liu
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Huang SJ, Hsiao MC, Lee JH, Chen CM. How I do it? Full endoscopic lumbar rhizotomy for chronic facet joint pain due to failed back surgery syndrome. Acta Neurochir (Wien) 2022; 164:1233-1237. [PMID: 35031892 DOI: 10.1007/s00701-021-05042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Failed back surgery syndrome (FBSS) is a general term for persistent postoperative back pain with or without accompanying radicular pain. FBSS may present as chronic facet joint pain. METHODS We introduced full endoscopic lumbar rhizotomy for patients suffering from facet joint pain due to FBSS. Facet joint block was introduced into the facet joint to determine whether pain improved after the injection. CONCLUSION With full endoscopic lumbar rhizotomy, the surgeon can identify the regions involved more clearly and directly. Although it is an invasive procedure, it provides a more effective and safe treatment for patients with FBSS-related facet joint pain.
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Wang C, Shi Z. [Research progress in creep characteristics of lumbar intervertebral disc]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1624-1629. [PMID: 33319547 DOI: 10.7507/1002-1892.202002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress in creep characteristics of lumbar intervertebral disc. Methods The relevant literature at home and abroad was systematically searched. Then, the concept and structural basis of lumbar disc creep, the description of creep characteristics, and the latest progress of its influencing factors were summarized and analyzed. Results The intervertebral disc is viscoelastic. After loading, the deformation increases with time. However, the degree of increase is not linear with time. That is creep, which plays an important role in buffering the load generated by human activities and absorbing energy in order to maintain stable movement of the spine. Both experimental and simulation studies can well describe the creep behavior of intervertebral disc. Various models including standard linear solid model and corresponding constitutive equations can quantify and compare the creep characteristics, which can be obviously changed by the degeneration of intervertebral disc and the mode of loading stress. Conclusion Creep is an important mechanical properties of intervertebral discs, and an in-depth understanding of the creep characteristics of lumbar intervertebral discs is of great guiding significance for the intervention and treatment of low back pain.
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Affiliation(s)
- Chao Wang
- Department of Spine Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, 200433, P.R.China
| | - Zhicai Shi
- Department of Spine Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, 200433, P.R.China
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Meloncelli S, Germani G, Urti I, Divizia M, Rosciano M, Puntillo F, Paladini A, Varrassi G. Endoscopic radiofrequency facet joint treatment in patients with low back pain: technique and long-term results. A prospective cohort study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20958979. [PMID: 33294037 PMCID: PMC7708704 DOI: 10.1177/1759720x20958979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
Aims: The aim of the study was to evaluate the efficacy of endoscopic rhizotomy
(ER) for denervation of lumbar facet joints in patients with chronic low
back pain (LBP) due to facet joint syndrome (FJS). Methods: A total of 50 consecutive patients suffering from chronic LBP due to facet
joints were screened to be treated with ER. The patients participating in
the study had a 2-year follow up. Numeric Rating Scale (NRS) and Oswestry
Disability Index (ODI) were assessed in the preoperative and postoperative
period. To evaluate secondary endpoints, patients were divided into groups.
One group included the patients previously treated with percutaneous
radiofrequency (RF). The other group comprised patients at their first
interventional treatment. We also compared patients dividing them by age and
by number of joints treated, trying to elucidate if these parameters could
be predictive of effectiveness of the procedure. Results: All patients had a reduction in NRS and an improvement in ODI. NRS was
reduced significantly after 1 month and remained the same until the end of
the study. ODI was significantly improved from T1 (1 month after surgery) up
to T7 (end of the study). The improvements did not differ whether already
treated with percutaneous rhizotomy or not. Patients less than 60 years or
with 1–2 joints treated had better improvement compared with the others. Conclusion: The results obtained demonstrate that ER for denervation of the facet joint
is an effective treatment in patients with chronic LBP, with consistent and
stable results at 2-year follow up. The technique has a rapid learning curve
and no major complications occurred. Moreover, the previous percutaneous RF
treatment had no influence on the results obtained with endoscopic
technique. There is evidence that best results are obtained in younger
patients and/or in patients with 1–2 joints treated. Lay summary Low-back pain has facet joints inflammation or degeneration as pain generator
in 20–40% of cases. Nervous lesion of the dorsal ramus innervating the facet
joints has been shown as an efficacious treatment to obtain good analgesia.
Percutaneous techniques have provided short term results for several
reasons. This research aimed to see whether endoscopic denervation, which
guarantees a more precise approach to anatomical structure, would result in
more durable results. The study conducted on 40 patients has made it clear
that this approach gives significant analgesia for at least 2 years, which
was the time of patient follow up.
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Affiliation(s)
| | | | | | | | | | - Filomena Puntillo
- Department of Emergency and Organ Transplants, University "Aldo Moro" of Bari, Bari, Puglia, Italy
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