Clinical therapeutic effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain / 实用医学杂志

Objective To investigate the clinical value and effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain. Methods From August 2008 to October 2013 ,96 patients diagnosed as lumbar zygapophysial joint pain were included in the research. 36 patients were treated by spinal nerve medial branch ablation through transforaminal endoscopic ,while 60 patients received conservative treatment. The visual analogue scale (VAS) and Japanese Orthopedics Association(JOA) scores before treatment,1,3,6 and 12 months after treatment were recorded and analyzed. The MacNab scores were recorded and analyzed 12 months after treatment. Results The VAS and JOA scores of surgical treatment group showed significant improvement compared with that before operation (P < 0.05),and there were no significant difference at each time point after surgery. The VAS and JOA scores of conservative treatment group in showed significant improved at 1 months after treatment compared with that before treatment(P<0.05),but there were no significant difference at each time after treatment compared with pretreatment. The VAS and JOA scores of surgical treatment group showed significant improvement compared with conservative treatment group at each time after treatment(P<0.05). The MacNab scores of surgical treatment group(94.44%)was significantly higher than that of conservative treatment group(33.33%). Conclusion The spinal nerve branches ablation under transforaminal endoscopic is an effective and safe minimally invasive spine surgery technique with important clinical value in the treatment of lumbar zygapophysial joint pain.

Survey of Sonoanatomic Distances For Lumbar Medial Branch Nerve Blocks in Healthy Volunteers

BACKGROUND: The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). METHODS: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. RESULTS: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P < 0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P < 0.001). CONCLUSIONS: We found many anatomic distances which may increase awareness of US guided LMBB.

Combined third occipital and C3 deep medial branch neurotomy in a patient with C2-3 facet joint osteoarthritis associated cervicogenic headaches: A case report

Cervicogenic headache is pain from the head due to various sources in the cervical spine. The C2-3 zygapophysial joints are the most commonly involved structure, and this type of headache could be relieved by blocks or neurotomy of the third occipital nerve. A 59-years-old female patient suffered from cervicogenic headaches due to severe C2-3 zygapophysial joint hypertrophy. Her pain was partially relieved by the third occipital radiofrequency neurotomy, and was almost completely removed by C3 deep medial branch neurotomy. Herein, we report a case of osteoarthritis associated cervicogenic headaches at the C2-3 zygapophysial joints and proposed a treatment option.

Efficacy of Ultrasonography-Guided Injections in Patients with Facet Syndrome of the Low Lumbar Spine

OBJECTIVE: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections. METHOD: Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure. RESULTS: Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7+/-6.5 sec; US: 263.4+/-5.9 sec; p=0.023). CONCLUSION: US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.

A biomechanical study on pressure changes of zygapophysial joints after cervical spine anterior operations / 中华创伤骨科杂志

Objective To explore the biomechanical mechanism of long-term complication of cervical spinal operations by measuring pressure changes of zygapophysial joints using pressure sensitive film (PSF) after cervical spine anterior operations. Methods C4,5 anterior discectomy and C4,5 anterior plate fixation were done on 10 fresh adult cervical spine specimens (C2～T1). PSF was put into zygapophysial joints and pressure changes were measured in positions of extension, left/right lateral bending and axial rotation on a universal testing machine. Results After cervical spine anterior operations, pressure of the adjacent facet joints increased. The differences were significant in extension and axial rotation (P

The relationship between the shape and area of cervical zygapophysial joint facet and cervical vertebral disease / 中国康复理论与实践

@#ObjectiveTo study the relationship between the shape and area of cervical zygapophysial joint facet and cervical vertebral disease. MethodsThe hyperosteogency rate of both cervical vertebral body and the susceptible site on the same cervical vertebral body were investigated on 50 sets of cervical vertebrae with hyperosteogency.The shape and area of cervical zygapophysial joint facet were observed on other 45 sets of normal adult cervical vertebrae. ResultsThe cervical vertebral zygapophysial joint facet showed mainly three shapes: round, elliptic and irregular, with elliptic shape predominate all. There is significance only on inferior facet on C4-5 and C5-6 joints (P<0.05).Conclusions There is some relationship between the shape and area of the cervical zygapophysial joint facet and the cervical hyperosteogency.

Determination of the False Positive Rate of Uncontrolled Diagnostic Block for Lumbar Medial Branch of Dorsal Rami / 대한마취과학회지

BACKGROUND: Patients without genuine zygapophysial joint pain exhibit a positive response to uncontrolled diagnostic blocks. We determined the false positive rate of single uncontrolled diagnostic zygapophysial joint block in patients with chronic back pain. METHOD: Thirty-five patients with chronic lower back pain were studied prospectively. All patients underwent a series of medial branch of dorsal rami blocks with lidocaine and bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. RESULTS: All patients proceeded with the injections. 16 patients (45%) had a definite or greater response to the initial lidocaine injection at one or more levels but only 5 (14%) had a 50% or greater response to a confirmatory injection of 0.5% bupivacaine. Using the confirmatory blocks as the criterion standard, the false positive rate of uncontrolled diagnostic blocks was 37% and the positive predictive value was only 31%. CONCLUSION: Uncontrolled diagnostic blocks may be unreliable for the diagnosis of lumbar zygapophysial joint pain.