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Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. [Radiofrequency denervation of the spine and the sacroiliac joint : A systematic literature search according to GRADE with new German S3 guideline]. Schmerz 2024:10.1007/s00482-024-00799-w. [PMID: 38427035 DOI: 10.1007/s00482-024-00799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This article summarizes the results of the German guideline on radiofrequency denervation of the facet joints and the sacroiliac joint. Evidence on the indications, test blocks and technical parameters are presented. OBJECTIVE The aim is to avoid overtreatment and undertreatment, which is also of socioeconomic importance. MATERIAL AND METHOD A systematic evaluation of the literature was carried out according to the grading of recommendations assessment, development and evaluation (GRADE) approach. A multidisciplinary guideline group has developed recommendations and statements. RESULTS Statements and recommendations were given for 20 key questions. There was an 87.5% consensus for 1 recommendation and 100% consensus for all other recommendations and statements. The guideline was approved by all scientific medical societies involved. Specific questions included the value of the medical history, examination and imaging, the need for conservative treatment prior to an intervention, the importance of test blocks (medial branch block and lateral branch block), choice of imaging for denervation, choice of trajectory, the possibility to influence the size of the lesion, stimulation, the possibility of revision, sedation and decision support for patients with anticoagulants, metal implants and pacemakers and advice on how to avoid complications. CONCLUSION Selected patients can benefit from well-performed radiofrequency denervation. The guideline recommendations are based on very low to moderate quality of evidence.
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Affiliation(s)
- Stephan Klessinger
- Neurochirurgie Biberach, Eichendorffweg 5, 88400, Biberach, Deutschland.
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | | | - Sebastian Gillner
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Sana Krankenhaus Benrath, Gräulicher Str. 120, 40625, Düsseldorf, Deutschland
| | - Holger Koepp
- Wirbelsäulenzentrum, St. Josefs-Hospital, Beethovenstr. 20, 65189, Wiesbaden, Deutschland
| | - Andreas Kopf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - Martin Legat
- Schmerzzentrum Zofingen, Hintere Hauptgasse 9, 4800, Zofingen, Schweiz
| | - Katharina Meiler
- Orthopädie, Städtisches Klinikum Magdeburg, Birkenallee 34, 39130, Magdeburg, Deutschland
| | - Heike Norda
- UVSD SchmerzLOS e. V., Fürsthof 24, 24534, Neumünster, Deutschland
| | | | - Matti Scholz
- ATOS Orthopädische Klinik Braunfels GmbH & Co. KG, Hasselbornring 5, 35619, Braunfels, Deutschland
| | - Phillipp J Slotty
- Klinik für Neurochirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Volker Tronnier
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| | - Martin Vazan
- Praxis für Neurochirurgie, Wirbelsäulen- und Rückenzentrum Dresden, Borsbergstr. 44, 01309, Dresden, Deutschland
| | - Karsten Wiechert
- Rückenzentrum am Michel, Ludwig-Erhard-Str. 18, 20459, Hamburg, Deutschland
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Abstract
Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA.
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Affiliation(s)
- Nicholas Said
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Timothy J Amrhein
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Nicholas C Nacey N
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Peter G Kranz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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Nolan JE, Sundet AD, Kagan BD, Lake TJ, Krag MH, Lunardini DJ. The positive prediction of single photon emission computed tomography/ computed tomography (SPECT/CT) in the outcome of intervention for cervical facet pain. Spine J 2022; 22:1622-1627. [PMID: 35537654 DOI: 10.1016/j.spinee.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have reported that magnetic resonance imaging (MRI) and computed tomography (CT) do not predict response to facet blocks. However, single photon emission computed tomography (SPECT) uptake within facet joints has been shown to correlate with pain relief after intervention in the lumbar spine. There is minimal data regarding the predictive value of single photon emission computed tomography/computed tomography (SPECT/CT) for neck pain. PURPOSE The aim of this study was to evaluate the utility of SPECT/CT in patients with axial neck pain for the identification of specific facet joints that would benefit from diagnostic and therapeutic facet joint steroid injections and/or medial branch block/RFA treatments. STUDY DESIGN A retrospective cohort study. PATIENT SAMPLE One hundred seventy-nine patients at a single institution pain center with neck pain and a SPECT/CT scan between 2009 and 2015. One hundred twelve patients had no prior intervention at the level of interest and met inclusion criteria. OUTCOME MEASURES Pain reduction at 50% and 80% thresholds within 24 hours of facet intervention. Concordance of facet intervention with the focus of maximal uptake on SPECT/CT scan. METHODS All patients were referred to our institution's Center for Pain Medicine and were treated with facet interventions. The site of facet intervention was determined by pain center providers based on their clinical examination and interpretation of images. Groups were formed based on whether the facet intervention included the level of maximal uptake on SPECT/CT scan. A positive response to intervention was defined at both 50% and 80% thresholds for reduction in pain within 24 hours of facet injection with steroid and local anesthetic or medial branch block with local anesthetic only. These were the facet interventions used for our data collection. A Chi-square statistic was used to analyze categorical data and a Student's t-test was used to analyze non-categorical data. SPSS (IBM Corp. IBM SPSS Version 24.0) was used for all analyses. RESULTS Of our 112 patients, Group 1 consisted of 89 with an intervention occurring at the level with increased uptake on SPECT/CT. Group 2 consisted of 23 patients with an intervention at a level without uptake on SPECT/CT. Demographic data did not significantly differ between cohorts. A Chi-square test of independence demonstrated that intervention at a level concordant with SPECT/CT was significantly correlated with self-reported pain relief thresholds of both 50% and 80% (p=.0002). CONCLUSIONS Facet interventions based on SPECT/CT scan uptake were more successful in pain reduction than those which were not. This suggests a role for SPECT/CT in diagnosing therapeutic targets for neck pain.
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Affiliation(s)
- John E Nolan
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Alec D Sundet
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Benjamin D Kagan
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Tiffini J Lake
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; Department of Anesthesiology, University of Vermont Medical Center, West Pavilion Level 2, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Martin H Krag
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - David J Lunardini
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA.
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Miller A, Griepp D, Rahme R. Beware the Wandering Needle: Inadvertent Intramedullary Injection During an Attempted Cervical Medial Branch Block. World Neurosurg 2021; 149:169-170. [PMID: 33647493 DOI: 10.1016/j.wneu.2021.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
A 27-year-old man developed sudden neck pain, severe quadriparesis, and right shoulder allodynia during an outpatient cervical medial branch block procedure. Cervical spine imaging revealed evidence of an interlaminar needle trajectory with abnormal signal in the right hemicord at the level of C4, consistent with intramedullary injection and contusion. Following a 48-hour stay in the intensive care unit, during which hemodynamic vasopressor support was administered to optimize spinal cord perfusion, the patient exhibited almost complete neurologic recovery with resolution of the neuropathic pain. He was eventually discharged home and underwent outpatient physical therapy for a mild residual right hemiparesis.
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Affiliation(s)
- Aaron Miller
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA
| | - Daniel Griepp
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA
| | - Ralph Rahme
- Division of Neurosurgery, SBH Health System, Bronx, New York, USA; CUNY School of Medicine, New York, New York, USA.
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Abstract
The purpose of this report is to describe the procedure for CT fluoroscopy- guided Cervical medial branch block and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning with visualization of bony landmarks and at the same time be aware of the adjoining soft tissue anatomy with good localization of adjacent critical non-targeted areas such as the neural foramina and the dorsal root ganglia. This serves as an alternative method for performing medial branch blocks and facet radiofrequency ablation.
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Affiliation(s)
- Majid Khan
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Division of Neuroradiology and Neuro-Interventional Radiology, 7220, Bloomberg Building. 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Sherif Meleka
- Department of Neurological Surgery, Johns Hopkins Hospital, 7220, Bloomberg Building, 1800 Orleans Street, Baltimore, MD 21287, United States.
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Dupont G, Yilmaz E, Iwanaga J, Oskouian RJ, Tubbs RS. Ossification of the mamillo-accessory ligament: a review of the literature and clinical considerations. Anat Cell Biol 2019; 52:115-119. [PMID: 31338226 PMCID: PMC6624327 DOI: 10.5115/acb.2019.52.2.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/27/2022] Open
Abstract
Ossification of the mamillo-accessory ligament (MAL) is a misunderstood phenomenon; however, many have posited that it can result in nerve entrapment of the medial branch of the dorsal ramus causing zygapophyseal joint related low back pain. The MAL has been studied anatomically by few, yet the data indicate possible associations between ossification of this ligament and spondylosis. It has been proposed that mechanical stress upon the lumbar spine may also lead to progressive ossification of the MAL into a bony foramen.
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Affiliation(s)
| | - Emre Yilmaz
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. Georg's, Grenada, West Indies
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Bae IS, Chun HJ, Bak KH, Yi HJ, Choi KS, Kim KD. Medial Branch Block Versus Vertebroplasty for 1-Level Osteoporotic Vertebral Compression Fracture: 2-Year Retrospective Study. World Neurosurg 2018; 122:e1599-e1605. [PMID: 30481629 DOI: 10.1016/j.wneu.2018.11.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Percutaneous vertebroplasty (VP) and medial branch block (MBB) are used to treat osteoporotic vertebral compression fractures (VCF). We compared the clinical outcomes, radiologic changes, and economic results of MBB with those of VP in treating osteoporotic VCFs. METHODS A total of 164 patients with 1-level osteoporotic VCF were reviewed retrospectively. The clinical outcomes were measured with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). To compare economic costs between groups, total hospital costs at the last follow-up day were calculated. RESULTS The patients were divided into 2 groups: 72 patients in the conservative group treated by MBB (MBB group) and 92 patients in the group who underwent VP (VP group). The VAS and ODI scores improved significantly within postoperative week 1 in the VP group compared with the MBB group. However, the VAS and ODI scores did not differ between the groups after 1 postoperative year. After 2 years of follow-up, 14 new fractures occurred in the VP group and 3 in the MBB group. The improvement in compression ratio was statistically greater in the VP group than in the MBB group. However, after 2 years the radiologic changes between groups did not differ statistically. After the final follow-up visits, the hospital costs were significantly lower in the MBB group. CONCLUSIONS After 2 years of follow-up, VP and MBB both had similar efficacy in terms of pain relief and radiologic changes. MBB was more cost effective than VP. Thus, MBB alone can be a possible alternative to VP in patients with 1-level osteoporotic VCFs.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kee D Kim
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
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Abstract
Ultrasonography has become an increasingly valuable and promising tool for performing image-guided spine interventions. The increase in the use of ultrasound utilization has led to more studies evaluating ultrasound-guided interventional spine procedures in comparison to fluoroscopy and computed tomography. Several studies have investigated the use of ultrasound for lumbosacral pain management procedures with favorable outcomes.
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Affiliation(s)
- Michelle Chi
- Department of Rehabilitation and Regenerative Medicine, New York Presbyterian Hospital of Columbia and Cornell, Harkness Pavilion, 180 Fort Washington Avenue, St 1-199, New York, NY 10032, USA
| | - Allen S Chen
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Harkness Pavillion, 180 Fort Washington Avenue, St 1-199, New York, NY 10032, USA.
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Seong HY, Lee MK, Jeon SR, Roh SW, Rhim SC, Park JH. Prognostic Factor Analysis for Management of Chronic Neck Pain: Can We Predict the Severity of Neck Pain with Lateral Cervical Curvature? J Korean Neurosurg Soc 2017; 60:456-464. [PMID: 28689395 PMCID: PMC5544378 DOI: 10.3340/jkns.2015.0910.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/25/2016] [Accepted: 08/05/2016] [Indexed: 01/08/2023] Open
Abstract
Objective Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors. Methods Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity. Results A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain. Conclusion We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.
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Affiliation(s)
- Han Yu Seong
- Department of Neurological Surgery, Bumin Hospital Seoul, Seoul, Korea
| | - Moon Kyu Lee
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chul Rhim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Park KD, Lim DJ, Lee WY, Ahn J, Park Y. Ultrasound versus fluoroscopy-guided cervical medial branch block for the treatment of chronic cervical facet joint pain: a retrospective comparative study. Skeletal Radiol 2017; 46:81-91. [PMID: 27815597 DOI: 10.1007/s00256-016-2516-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/11/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the mid-term effects and advantages of the ultrasound (US)-guided with fluoroscopy(FL)-guided cervical medial branch blocks (CMBBs) for chronic cervical facet joint pain through assessment of pain relief, functional improvement, and injection efficiency. METHODS Patients with chronic cervical facet joint pain who received US- (n = 68) or FL-guided CMBBs (n = 58) were included in this retrospective study. All procedures were performed using a FL or US. The complication frequencies, treatment effects, functional improvement, and injection efficiency of CMBBs were compared at 1, 3, and 6 months after the last injection. RESULTS Both the NDI and VNS scores showed improvements at 1, 3, and 6 months after the last injection in both groups, with no significant differences between groups (p < 0.05). Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), the number of injections, sex, analgesic use, and age were not independent predictors of treatment success. Compared with FL-guided CMBB, US-guided CMBB was associated with a shorter administration duration and fewer needle passes. CONCLUSIONS Our results suggest that, compared with FL-guided CMBBs, US-guided CMBBs require a shorter administration duration and fewer needle passes, while providing similar pain relief and functional improvements. Therefore, US-guided CMBBs can be considered as an effective alternative for the conservative management of chronic cervical facet joint pain.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Dong-Ju Lim
- Seoul Spine Institute, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Woo Yong Lee
- Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - JaeKi Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Yongbum Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
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Klessinger S. Zygapophysial joint pain in selected patients. World J Anesthesiol 2015; 4:49-57. [DOI: 10.5313/wja.v4.i3.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
The zygapophysial joints (z-joints), together with the intervertebral disc, form a functional spine unit. The joints are typical synovial joints with an innervation from two medial branches of the dorsal rami. The joint capsule and the surrounding structures have an extensive nerve supply. The stretching of the capsule and loads being transmitted through the joint can cause pain. The importance of the z-joints as a pain generator is often underestimated because the prevalence of z-joint pain (10%-80%) is difficult to specify. Z-joint pain is a somatic referred pain. Morning stiffness and pain when moving from a sitting to a standing position are typical. No historic or physical examination variables exist to identify z-joint pain. Also, radiologic findings do not have a diagnostic value for pain from z-joints. The method with the best acceptance for diagnosing z-joint pain is controlled medial branch blocks (MBBs). They are the most validated of all spinal interventions, although false-positive and false-negative results exist and the degree of pain relief after MBBs remains contentious. The prevalence of z-joint pain increases with age, and it often comes along with other pain sources. Degenerative changes are commonly found. Z-joints are often affected by osteoarthritis and inflammatory processes. Often additional factors including synovial cysts, spondylolisthesis, spinal canal stenosis, and injuries are present. The only truly validated treatment is medial branch neurotomy. The available technique vindicates the use of radiofrequency neurotomy provided that the correct technique is used and patients are selected rigorously using controlled blocks.
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Abstract
Fluoroscopy-guided interventions on facet joints have been used for decades for the symptomatic management of pain in spinal disorders. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. Pulsed fluoroscopy is one of the most widely used and well-accepted tools for these procedures. This article presents a technical overview of commonly used fluoroscopy-guided interventions on the facet joints of the cervical and lumbar spine, such as facet joint injection, blockade of the medial nerve branches and radiofrequency ablation.
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Affiliation(s)
- J Artner
- Schmerztherapie, Orthopädische Universitätsklinik Ulm am RKU, Oberer Eselsberg 45, 89081, Ulm, Deutschland.
| | - S Klessinger
- Nova Clinic, Biberach, Deutschland
- Neurochirurgische Universitätsklinik Ulm, Ulm, Deutschland
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