Neuromodulación percutánea utilizando radiofrecuencia pulsada versus crioablación en pacientes con síndrome facetario lumbar / Percutaneous neuromodulation with pulsating radiofrequency vs cryoablation for the treatment of patients with lumbar facet syndrome

Resumen: Introducción: El dolor en columna lumbar afecta a un alto porcentaje de la población y presenta un significativo impacto socioeconómico. El síndrome facetario lumbar tiene una prevalencia entre 15-31% con incidencia a lo largo de la vida de hasta 52% en algunas series. Debido al empleo de distintos tipos de tratamiento y diversos criterios de selección de los pacientes, la tasa de éxito varía en la literatura. Objetivo: Comparar resultados de tratamiento con rizólisis aplicando radiofrecuencia pulsada versus crioablación en pacientes con diagnóstico de síndrome facetario lumbar. Material y métodos: De Enero de 2019 a Noviembre de 2019, ocho pacientes fueron divididos aleatoriamente en dos grupos: el grupo A tratados con radiofrecuencia pulsada y el grupo B tratados con crioablación. Se evaluó el dolor con la escala visual análoga y el índice de discapacidad de dolor lumbar de Oswestry a las cuatro semanas, además de tres y seis meses. Resultados: El seguimiento fue de seis meses. De forma inmediata los ocho pacientes (100%) refirieron mejoría de los síntomas y del dolor. De los cuatro pacientes que se encontraban en limitación funcional intensa, uno pasó a estar sin limitación funcional, dos de ellos pasaron a limitación funcional mínima y uno a limitación funcional moderada al primer mes; se reportaron diferencias estadísticamente significativas. Conclusiones: Ambos tratamientos controlan el dolor en el corto plazo; también hay una mejoría de las capacidades físicas. La morbilidad que acompaña a la neurólisis, ya sea radiofrecuencia o crioablación, es muy baja.

Abstract: Introduction: Lumbar spine pain affects a high percentage of the population and has a significant socioeconomic impact. Lumbar facet syndrome has a prevalence between 15-31% with lifetime incidence of up to 52% in some series. Due to the use of different types of treatment and different patient selection criteria, the success rate varies in the literature. Objective: To compare results of treatment with rhizolysis applying pulsed radiofrequency versus cryoablation in patients diagnosed with lumbar facet syndrome. Material and methods: From January 2019 to November 2019, eight patients were randomly divided into two groups: group A treated with pulsed radiofrequency and group B treated with cryoablation. Pain was assessed with the visual analogue scale and the Oswestry low back pain disability index at four weeks, in addition to three and six months. Results: Follow-up was six months. Immediately the eight patients (100%) reported improvement in symptoms and pain. Of the four patients who were in intense functional limitation, one of them became without functional limitation, and two of them went to minimum functional limitation and one to moderate functional limitation at the first month, statistically significant differences were reported. Conclusions: Both treatments control pain in the short term; there is also an improvement in physical abilities. The morbidity accompanying neurolysis either radiofrequency or cryoablation is very low.

Factores de crecimiento ozonizados en el síndrome facetario lumbar / Ozonized growth factors in the lumbar facet syndrome

El tratamiento de las patologías discales y degenerativas que afectan a las articulaciones interfacetarias de la columna vertebral representan entre ambas más del 95% de los objetivos curativos en esta área del cuerpo, en razón de esto, esta investigación evalúa los efectos de los factores de crecimiento ozonizados en pacientes con diagnóstico de síndrome facetario lumbar, así como también, valorar la intensidad del dolor en el síndrome facetario, determinando el grado de movilidad articular previo y posteriora la infiltración. Métodos: la presente investigación se considera un estudio descriptivo y prospectivo, con un diseño es preexperimental, en pacientes que acudieron a la consulta de terapia del dolor del Hospital Dr. Pedro García Clara, en Ciudad Ojeda, estado Zulia-Venezuela. Los resultados se expresaron como valores absolutos, en porcentajes, media ± desviación estándar (M±DE), analizando las diferencias de los resultados mediante la prueba "t" de Student, cuando fueron aplicables, tomando un valor de p<0.05. Resultados: se evidencia, que los factores de crecimiento ozonizados infiltrados en los pacientes con diagnóstico de síndrome facetario lumbar, tienen efectos clínicos significativos, en cuanto a la disminución de la intensidad del dolor y el aumento del grado de movilidad articular. Conclusiones: el uso del plasma rico ozonizado es una técnica efectiva para disminuir la intensidad del dolor cuando es utilizado en el síndrome facetario ya que permite una aumento significativo de los grados de movilidad articulares de la columna lumbar (flexión, extensión e inclinación. Es una técnica sencilla, eficaz, económica y con efectos adversos mínimos(AU)

The treatment of the disc and degenerative pathologies that affect the interfaceative joints of the spine represent between them more than 95% of the healing objectives in this area of the body, because of this, this research evaluates the effects of the growth factors Ozonized in patients with a diagnosis of lumbar facet syndrome, as well as assessing the intensity of pain in facet syndrome, determining the degree of joint mobility before and after infiltration. Methods: the present investigation is considered a descriptive and prospective study, with a pre-experimental design, in patients who attended the pain therapy consultation of the Dr. Pedro García Clara Hospital, in Ciudad Ojeda, Zulia-Venezuela state. thee results were expressed as absolute values, in percentages, mean ± standard deviation (M ± SD), analyzing the differences of the results by means of the Student "t" test, whenapplicable, taking a value of p <0.05. Results: it is evidenced that infiltrated ozonized growth factors in patients with a diagnosis of lumbar facet syndrome, have significant clinical effects, in terms of the decrease in pain intensity and the increase in the degree of joint mobility. Conclusions: the use of ozonated rich plasma is an effective technique to reduce the intensity of pain when used in facet syndrome because it allows a significant increase in the degrees of joint mobility of the lumbar spine (flexion, extension and tilt.) It is a simple, effective technique, economic and with minimal adverse effects(AU)

Effectiveness of Repeated Radiofrequency Neurotomy for Facet joint Syndrome after Microscopic Discectomy

OBJECTIVE: Postoperative facet joint syndrome requiring radiofrequency neurotomy (RFN) is a relatively common problem following microscopic discectomy. However, the efficacy of repeated RFN after microscopic discectomy has not been clearly documented. The purpose of this study was to determine the success rate and symptom-free duration of repeated RFN for facet joint syndrome after microscopic discectomy. METHODS: Medical records from 56 patients, who had undergone successful initial RFN following microscopic discectomy, experienced recurrence of pain, and subsequently had repeated RFN, were reviewed and evaluated. Responses of repeated RFN were compared with initial radiofrequency neurotomy for success rates and duration of relief. The criterion for RFN to be successful was defined as greater than 50% relief from pain and sufficient satisfaction of patients with prior RFN to have repeated RFN. RESULTS: Fifty-six patients (41 women and 15 men; mean age=48 years) had repeated RFNs, which were successful in all except three patients. RFN denervated three bilateral segments (L3-L4, L4-L5, and L5-S1) in all patients. Mean duration of relief after initial RFN was 9.2 months (range 3-14). The mean duration of relief after secondary RFN in 53 patients was 9.0 months (range 4-14). The success rates and duration of relief remained consistent after subsequent RFNs. CONCLUSION: Repeated RFN for lumbar facet joint pain after microscopic discectomy is an effective palliative treatment. It provided a mean duration of relief of 9.0 months and >94% success rate.

The Efficacy of Repeated Radiofrequency Medial Branch Neurotomy for Lumbar Facet Syndrome

OBJECTIVE: Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. METHODS: A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. RESULTS: There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. CONCLUSION: Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects. Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.

Short Term Outcomes and Prognostic Factors Based on Radiofrequency Thermocoagulation on Lumbar Medial Branches / 대한통증학회지

BACKGROUND: Lumbar zygapophysial joints are a common source of chronic lower back pain and radiofrequency thermocoagulation (RF) of the medial branches (MB) has been shown to be effective at providing substantial pain relief for chronic low back pain.Therefore, we carried out this study to determine the short term outcomes and prognostic factors of RF on the MB of patients with lumbar facet syndrome. METHODS: We performed RF in fourteen patients who showed greater than 80% pain relief up to three times after a diagnostic MB block was conducted using 0.3 ml of 0.5% bupivacaine.Using 10 cm curved electrodes with 10-mm active tip, a 60 second, 80 degrees C lesion was made after electrical stimulation at 50 Hz for sensory and 2 Hz for motor nerve testing.The degree of pain relief was then assessed after 2 weeks, and again after 3 months using a visual analog scale (VAS) and a four point Likert scale.The outcome was regarded as 'success' if at least a 50% reduction in the VAS was observed.Possible prognostic factors between the two groups were also evaluated. RESULTS: The success rate was 71.4% (10/14) after three months of follow-up. However, there were transient complications, such as neuritis like syndrome, in 4 patients. In addition, short symptom duration and low minimal voltage (< 0.4 V) for sensory stimulation were shown to be the relevant prognostic factors for a successful outcome. CONCLUSIONS: RF may be an alternative to repeated MB block or intraarticular injection for palliation of lumbar facet syndrome. For better outcomes, early diagnosis and strict patient selection should be coupled with efforts to avoid anatomically incorrect RF.

The Effect of Intra-articular Hyaluronic Acid in Facet Syndrome of the Lumbar Spine

OBJECTIVE: To evaluate the efficacy of intra-articular hyaluronic acid injection and to compare this with the efficacy of steroid injection for the treatment of facet syndrome of the lumbar spine. METHOD: Sixty-eight patients with facet syndrome of the lumbar spine were assigned two groups at random to receive an intra-articular injection into the facet joint. One group received a intra-articular injection of the facet joint three times at 1 week apart with a mixture of hyaluronic acid 0.6~0.7 ml and 1% lidocaine 0.2 ml. The other group received a intra-articular injection of the facet joint one time with a mixture of triamcinolone 10 mg and 1% lidocaine 0.5~1 ml. The effectiveness of treatment was assessed with the visual analogue scale (VAS), and the patient's life activities were assessed with the modified Oswestry questionnaire. RESULTS: The VAS and the patient's life activity of the two groups all showed improvement at 1 week, 1 month and 3 months after injection, but there was no significant difference in the VAS scores and the patient's life activity scores between the two groups. CONCLUSION: The intra-articular injection of hyaluronic acid would be a good treatment method for facet syndrome of the lumbar spine.

Lumbar Lordosis in Low Back Pain Patients

The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies. On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings. There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease. It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.

Rercutaneous Radiofrequency Denervation in Lumbago

A technique radiogrequency localization and coagulation of articular nerves supplying the lumbar facets is described and reported from a series of 46 patients with clinical diagnosis of facet syndrome over a 4-year period. None of them had clinical or radiologic evidence of a lumbar disc hrniation, and all had exhausted conservative treatment. The literature reviewed for anatomical accuracies in denervation of the medial branch of posterior primary(dorsal) ramus. The technique of facet denervation is simple and safe and relief of pain was achieved in 78% of the patient, the morbidity remains quite low.

Clinical Evaluation of the Intra / 대한정형외과학회잡지

Since the term “facet syndrome” was introduced by Ghormley in 1933, arthropathy of the lumbar facet joint has long been recognized as an important source of low back pain, even sciatic pain. And facet joint injection has been helpful in the diagnosis and therapy for this facet syndrome. However, considering the possible complications such as infection, neurologic deficit and difficulty in locating the symptpmatic joint, and placebo effect, we have frequently doubted about clinical application of these procedures. This study is a retrospective review of 18 patients who got lumber facet joint injection for low back and leg pain with various previous indication that are not response to convential therapy for 2 months or more for therapeutic purpose. The response to facet joint injection was analyzed according to the entire spectrum of symptoms, physical findings, and X-ray findings. 13 or 15 patients with back pain with thigh or groin pain aggrevated by extension/rotation of trunk had successful response but patients with leg pain below the knee joint or pathology in the other structures in the spine got poor response. Strict diagnostic criteria through scoring system, provocation test, relief test and analysis of patient's signs and symptoms is needed to get higher degree of predictability and effectiveness of facet joint injection.

The clinical therapeutic effect of facet block in the management of low back pain / 대한정형외과학회잡지

In spite of numerous clinical and patho-anatomical studies made in the past, there are still different opinions concerning the machanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with leg radiation, so we have studied and analyzed the effect of the injection of mixture methylprednisolone acetate suspension (20-40 mg) and local anesthetic (1% procaine, 1cc) into the posterior facet joint. In this paper, the records of 41 in-patients who have chiefly compalned of low back pain wlth leg radiation and have been treated at the Departmnt of Orthopedics, Han Yang University Hospital from May, 1979 to April, 1980 were studied. The following results are recognized by observing and analyzing their chief complalnts, physical examination, x-ray findings, the effect of facet block and the follow-up studies after facet block. 1. Low back pain with sciatica was 1.9 times more common in female than male, and frequently occured In 4th to 6th decades (75.7%). 2. The abnormal findings of plain x-rays were osteophyte (35.6%), marginal sclerosis (27.1%), narrowing of disc spce (18.6%), lumbarization (11.9%), spina bifida (3.4%), and tropism (3.4%). 3. The most frequent site of abnormal posterior facet joints was at the level between 4th and 5th lumbar vertebra (42.9%), and all were on lower lumber region. 4. The range of lumbar motion was decreased in the cases of abnormal posterior facet jolnt or degenerative changes, and it was especially more decreased in the combined cases. 5. The effect of facet block was as follows; In initial assessment, 29 of 41 cases (70.7%) showed complete rellef and one month later, 16 of 29 cases (55.2%) showed continuous rolief, 4 of 18 cases (22.2%) which were followed for 3 more months showed complete relief. 6. The effect of facet block according to pain character was as follows: 20 of 26 cases (76.9%) of numbness, 5 of 6 cases (83.3%) of dull pain and 4 of 8 cases (50.0%) of radlating pain were completely relleved and a case of burning pain was partially relleved.