Acute back pain - Role of injection techniques and surgery: WFNS spine committee recommendations.

Objective: Lower back pain is a significant cause of morbidity, and despite a range of interventions available, there is a lack of consensus on the most efficacious treatments. The aim of this systematic review is to formulate a list of recommendations for the role of spinal injections and surgery in the treatment of acute back pain. Methods: A systematic literature search from 2012 to 2022 was conducted on Pubmed, Medline, and Cochrane Central Register of Controlled Trials for papers focusing on the role of injections and surgery for the management of acute lower back pain. Inclusion criteria included randomised controlled trials, as well as prospective and retrospective studies reporting primary outcomes (pain improvement (VAS score) and back-specific functional status) and secondary outcomes (post-procedure complications). These data were reviewed, presented, and voted on by an expert panel consisting of 14 attending spine surgeons from 14 countries at the consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. A two-round consensus-based Delphi method was used to generate consensus, and topics with >66% agreement were categorized as having reached consensus. Results: 100 studies met inclusion criteria. Of these, 20 were selected by the committee for full text review and presented at the consensus meeting. The committee voted on 8 statements and achieved consensus on the following 7 statements: (1) Epidural steroid injections (ESIs) show significant benefit to discogenic back pain; (2) A lateral approach is superior to a midline approach for ESIs; (3) Short-term (<1 week) effect of ESIs is similar between steroids; (4) ESIs have a variety of potential complications; (5) CT or fluoroscopy guidance can be used for lumbar medial branch blocks; (6) Lumbar medial branch radiofrequency ablations can be performed on patients with recurrent pain after a successful ESI, and (7) Acute lower back pain is usually self-limiting, resolves in <6 weeks, and does not require surgical intervention. Conclusion: Given significant treatment heterogeneity, we provide the latest, evidence-based recommendations for management of acute lower back pain. ESIs are effective at short-term pain relief, and surgical intervention should be reserved for patients failing conservative measures.

[Modern aspects to the diagnosis and non-surgical treatment of low back pain]. / Sovremennye podkhody k diagnostike i nekhirurgicheskomu lecheniyu boli v nizhnei chasti spiny.

Low back pain is one of the most common complaints in primary care. This pain is usually nonspecific and musculoskeletal. However, identification and exclusion of specific causes of pain as early as possible are important for specialists since their underestimation can sometimes lead to life-threatening consequences. The authors analyze literature data on the key facts of anamnesis («red flags¼), management of patients with low back pain with emphasis on modern concepts and recommendations for diagnostics, identifying the dominant nature and cause of pain, differential diagnosis, and diagnostic significance of neuroimaging. Special attention is paid to existing options for conservative (drug and non-drug therapy) and interventional treatment methods, which have become increasingly popular in recent years.

Comparative Outcome of Lidocaine Versus Bupivacaine for Cervical Medial Branch Block in Chronic Cervical Facet Arthropathy: A Randomized Double-Blind Study.

OBJECTIVE: This study evaluated the effect of prolonged concordant response and functional clinical improvement between lidocaine and bupivacaine for cervical medial branch block (CMBB) in chronic cervical facet syndrome. METHODS: Sixty-two patients diagnosed with chronic cervical facet syndrome were randomized into either lidocaine or bupivacaine groups. The therapeutic CMBB was performed under ultrasound guidance. Either 2% lidocaine or 0.5% bupivacaine with a volume of 0.5-1 mL per level was injected according to the patient's pain symptoms. The patients, pain assessor, and pain specialist were blinded. The primary outcome was the duration of pain reduction by at least 50%. The Numerical Rating Scale of 0-10 and the Neck Disability Index questionnaire were recorded. RESULTS: There was no significant difference in the duration of 50% and 75% pain reduction and Neck Disability Index between the lidocaine and bupivacaine groups. Lidocaine provided significant pain reduction up to 16 weeks (P < 0.05) and significant improvement in neck functional outcomes up to 8 weeks (P < 0.01) compared to the baseline. While bupivacaine yielded significant pain alleviation for up to 8 weeks for pain upon neck mobilization (P < 0.05) and demonstrated notable improvement in neck function up to 4 weeks (P < 0.01) compared to the baseline. CONCLUSION: CMBB using lidocaine or bupivacaine provided clinical benefits in prolonged analgesic effect and improving neck functions for chronic cervical facet syndrome. Lidocaine illustrated better performance and could be considered a local anesthetic of choice regarding the prolonged concordance response.

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.

Valoración de la eficacia analgésica del bloqueo facetario lumbar en función de la técnica de imagen utilizada: ecografía frente a fluoroscopia / Evaluation of the analgesic efficacy of lumbar facet block as a function of the imaging technique used: ultrasound versus fluoroscopy

Objetivo: En la lumbalgia mecánica por síndrome facetario lumbar están indicadas como opciones terapéuticas los bloqueos periarticulares e intrarticulares de las articulaciones facetarias lumbares, así como el bloqueo nervioso del ramo medial de la raíz o ramo posterior del nervio raquídeo. El bloqueo nervioso del ramo medial puede llevarse a cabo mediante control ecográfico o radioscópico. El objetivo de este estudio es valorar si existen diferencias en la eficacia analgésica del bloqueo en función de la técnica de imagen con la que se lleva a cabo (ecografía frente a radioscopia-fluoroscopia). Pacientes y método: Se ha realizado un estudio clínico transversal durante el mes de noviembre de 2020, analizando los bloqueos facetarios realizados en la Unidad del Dolor del Hospital Universitario Clínico de Salamanca entre mayo de 2018 y septiembre de 2020. La muestra analizada cuenta con 315 pacientes, de los cuales 212 fueron sometidos a bloqueo facetario ecoguiado en consulta y 103 se realizaron bajo control radioscópico en el quirófano. Se ha evaluado la medida del dolor inicial, previo al bloqueo, mediante la escala analógica visual (EVA inicial), así como la EVA final y el porcentaje de mejoría subjetiva recogido en los 15 días posteriores a la realización de la intervención, valorando sus diferencias en función de la técnica de imagen empleada para su realización. Resultados: Los valores de EVA final de los pacientes que se realizaron el bloqueo mediante radioscopia y la de aquellos que lo realizaron ecoguiado fue similar, con un resultado final de 3,5 (mediana), así como el porcentaje de mejoría subjetiva que también fue similar en ambos grupos, alcanzando esta el 50 %. Conclusiones: No existen diferencias en la eficacia analgésica del bloqueo facetario lumbar en función de la técnica de imagen empleada para su realización: radioscopia-fluoroscopia o ecografía.(AU)

Objective: In mechanical low back pain due to lumbar facet syndrome, periarticular and intra-articular blocks of the lumbar facet joints as well as nerve blocks of the medial branch of the spinal nerve root or posterior branch of the spinal nerve are indicated as therapeutic options. The nerve block of the medial branch can be performed by ultrasound or radioscopic monitoring. The aim of this study is to assess whether there are differences in the analgesic efficacy of the block depending on the imaging technique used (ultrasound versus fluoroscopic-radioscopy). Patients and method: A cross-sectional clinical study was conducted during the month of November 2020, analysing the facet blocks performed in the Pain Unit of the Hospital Universitario Clínico de Salamanca between May 2018 and September 2020. The sample analysed consisted of 315 patients, of whom 212 underwent an echo-guided facet block in consultation and 103 were performed under radioscopic control in the operating theatre. The initial pain measurement, prior to the block, was evaluated using the visual analogue scale (initial VAS), as well as the final VAS and the percentage of subjective improvement recorded 15 days after the intervention, assessing the differences according to the imaging technique used for its performance. Results: The final VAS values of the patients who underwent radioscopic block and those who underwent echo-guided block were similar, with a final result of 3.5 (median), as was the percentage of subjective improvement, which was also similar in both groups, reaching 50 %. Conclusions: There are no differences in the analgesic efficacy of the lumbar facet block depending on the imaging technique used for its performance: fluoroscopy-radioscopy or ultrasound.(AU)

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

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.

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.

Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain.

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS: There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS: ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.

Facet Arthrodesis with the FFX Device: One-Year Results from a Prospective Multicenter Study.

BACKGROUND: Facet osteosynthesis can be performed to treat facet syndrome (FS) and reduce spinal instability following laminectomy in patients with lumbar spinal stenosis (LSS). The present study evaluated clinical and radiological outcomes following facet osteosynthesis with the FFX device. METHODS: Patients with FS or LSS were prospectively enrolled in a single-arm, multicenter study. The device was placed at affected levels with or without concomitant posterior lumbar interbody fusion (PLIF) procedures. The visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Computed tomography scans to assess fusion and migration were performed 1 year following surgery. RESULTS: Fifty-three patients (26 men/27 women) with a mean age of 65.0 ± 9.6 years (range: 37-83 years) were enrolled. A total of 205 FFX devices were implanted with 15 patients undergoing concurrent PLIF procedures. There were no intraoperative or postoperative surgical complication reported, and no patient required revision surgery. Mean VAS leg and back pain scores significantly improved from 5.57 to 2.09 (P < .001) and 5.74 to 3.13 (P < .001), respectively, between the preoperative and 1 year follow-up assessments. Mean ODI scores also significantly improved from 44.7% to 24.0% (P < .001) during the same time period. Facet fusion occurred with 86.3% of device placements after 12 months. There was 1 (0.5%) asymptomatic device migration. Eight devices (3.9%) were considered misplaced. CONCLUSIONS: The use of the FFX device is associated with a significant reduction in both pain and disability following surgery with a high facet joint fusion rate. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: This is the first study reporting clinical experience using the FFX device to facilitate facet osteosynthesis. The ability of the device to relieve pain, reduce disability, and enhance lumbar facet fusion with a low rate of device misplacement and migration was demonstrated.

[Analysis of the clinical efficacy of platelet-rich plasma therapy in the treatment of patients with isolated facet-syndrome of the lumbar spine]. / Analiz klinicheskoi éffektivnosti primeneniia PRP-terapii pri lechenii patsientov s izolirovannym fasetochnym sindromom poiasnichnogo otdela pozvonochnika.

AIM: To analyze clinical results of the surgical treatment of patients with isolated facet-syndrome of the lumbar spine using platelet-rich plasma (PRP) therapy for arcuate spine joints. MATERIAL AND METHODS: The study included 49 patients, aged 39.5 (34; 45), who, after provocative tests, were diagnosed with isolated facet syndrome and operated on from 2015 to 2018 using PRP therapy. A visual analogue pain scale (VAS), Oswestry questionnaire (ODI), Macnab subjective satisfaction scale, and the presence of complications were used to evaluate clinical efficacy. Dynamic evaluation was made on average 18 months after surgery. RESULTS AND CONCLUSION: PRP therapy is a highly effective method for treatment of patients with isolated facet syndrome caused by degenerative diseases of the facet joints. Clinical efficacy is confirmed by the persistent significant reduction of pain symptoms and restoration of functional status in the early and late postoperative periods with low risks of adverse outcomes.

[Comparative analysis of the effectiveness of PRP therapy and facetoplasty in older patients with isolated lumbar facet syndrome: long-term results of a randomized controlled trial.]

The aim of the study was to conduct a comparative analysis of the long-term results of applying PRP therapy and facetoplasty in patients of the older age group with an isolated lumbar facet syndrome. The study included 159 patients over the age of 65 with symptomatic degenerative disease of the facet joints, who were operated on using PRP therapy and facethoplasty in the period from 2016 to 2018. Independent sequential randomization (1:1) of 144 patients was performed using software. A visual analogue pain scale (VAS), Oswestry disability index (ODI), Macnab subjective satisfaction scale, and the presence of complications were used to assess clinical efficacy. As a result, it was established that PRP therapy and facetoplasty are effective methods for treating isolated lumbar facet syndrome in older patients. In the late postoperative period, the best clinical outcomes were recorded according to VAS and the ODI index in the group of patients who underwent PRP therapy.

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)

Clinical utility of ozone therapy for musculoskeletal disorders.

Oxygen-ozone (O3) therapy serves as an alternative medical technique that increases the oxygen in the body along with the introduction of O3. O3 therapy has finally reached a level where the biological mechanisms of action have been understood, showing that they are in the domain of physiology, biochemistry, and pharmacology. Few clinical applications have been reviewed here as well as exemplifying that O3 therapy is particularly useful in musculoskeletal disorders. In the therapeutic range, O3 can be used as a more effective and safe substitute of standard medications. O3 therapy has been used for many years for its ability to inactivate various viruses, cancer, and acquired immune deficiency syndrome but is now making strides in the treatment of musculoskeletal disorders such as rheumatoid arthritis, lumbar facet joint syndrome, subacromial bursitis, carpal tunnel syndrome, osteoarthritis, hip bursitis, shoulder adhesive capsulitis, herniated disc, and temporomandibular joint disorder.

[The chondroprotector mucosat in an integrated approach to the treatment of nonspecific back pain]. / Khondroprotektor mukosat v integrirovannom podkhode k lecheniiu patsientov s nespetsificheskoi bol'iu v spine.

A nonspecific back pain is in the vast majority of all possible cases of dorsopathies. The sources of back pain may be myogenic dysfunction, intervertebral disc pathology or osteoarthritis of the archicular (facet) joints of the spine, including myofascial pain syndrome. A differentiated approach to the treatment of spondylarthrosis is still an unsolved problem. The article discusses important issues of integration of non-drug treatment methods and drug therapy of nonspecific back pain in patients with facet syndrome. Special attention is paid to SYSADOA group chemicals, in particular chondroitin sulfate (mucosat). These drugs have proven analgesic and anti-inflammatory effects and also are able to improve the structure of the cartilaginous tissue, slowing the progression of the disease.

Rehabilitation of a Young Athlete With Extension-Based Low Back Pain Addressing Motor-Control Impairments and Central Sensitization.

OBJECTIVE: To describe the conservative management of a young athlete with extension-based (EB) low back pain (LBP). BACKGROUND: We present the case of a 15-year-old female high school gymnast with a 4-year history of EB LBP. Magnetic resonance imaging revealed a healed spondylolysis and significant atrophy with fatty infiltrate of the lumbar multifidi muscles (LMM). She had several courses of outpatient orthopaedic rehabilitation that focused on core muscle strengthening (improving activation and strength of the LMM and transversus abdominus muscle in a neutral pelvic position) without long-lasting improvement. She was unable to tolerate higher levels of training or compete. DIFFERENTIAL DIAGNOSIS: The LMM are rich in muscle spindles and provide continuous feedback to the central nervous system about body position. Atrophy and fatty infiltrate of the LMM can compromise neuromuscular function and contribute to dysfunctional movement patterns that place a greater demand on lumbar spine structures. Ongoing motor-control impairments perpetuate nociceptive input, leading to central sensitization. TREATMENT: The athlete had difficulty controlling trunk extension during sport-specific activities; she moved early and to a greater extent in the lumbar spine. The aim of the treatment was to teach the athlete how to control her tendency to overload her lumbar spine when bending backward, thus reducing nociceptive input from lumbar spine structures and desensitizing the nervous system. UNIQUENESS: Treating EB LBP by addressing motor-control impairments and cognitive-affective factors as opposed to core strengthening. CONCLUSIONS: Activity modification, bracing, and traditional core-strengthening exercises may not be the most appropriate treatment for athletes experiencing EB LBP. Addressing cognitive-affective factors in addition to correcting maladaptive motor behavior and moving in a pain-free range reduces nociceptive input, desensitizes the nervous system, and allows athletes to gain control over their pain.

Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance.

BACKGROUND: Transforaminal epidural steroid injections (TFESIs) and facet joint blocks can be performed under fluoroscopy or computed tomography (CT) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESIs and facet joint blocks under CT guidance vs. fluoroscopic guidance. METHODS: The primary outcome of this retrospective cohort study was the difference between the estimated effective dose (ED) of CT guidance and fluoroscopic guidance for TFESIs and facet joint blocks. Patients who had undergone these procedures with both CT and fluoroscopic guidance were eligible for this study. Dose-length product for CT-guided procedures and dose-area product for fluoroscopic-guided procedures were retrospectively collected and converted to ED. Within- or between-group comparisons were performed with appropriate nonparametric tests, using a P value of < 0.05 to indicate statistical significance. RESULTS: The 42 patients included in this study underwent a total of 100 procedures. The median estimated ED differed significantly between CT-guided injections and fluoroscopic-guided injections (1.59 mSv (interquartile range [IQR] 0.78 to 3.09) vs. 0.19 mSv (IQR 0.11 to 0.30) (Wilcoxon signed rank test, P < 0.001). CONCLUSIONS: The study results suggest that TFESIs and facet joint blocks performed with CT guidance are associated with more than 8 times higher patient radiation dose exposure compared to fluoroscopic guidance. There needs to be more vigilance with regards to CT guidance in interventional pain procedures.

[Analysis of the clinical efficacy of fasetoplasty method for the treatment of facet syndrome at lumbar spine in patients with middle and old age group].

The aim of the study was to analyze results of using of fasetoplasty method in the treatment of facet-syndrome at lumbar spine in patients with middle and old age groups. The study included 227 patients older than 65 years with degenerative-dystrophic diseases of the lumbosacral spine and the clinical manifestations in the form of a facet syndrome, which in the period from 2010 to 2013 years made fasetoplasty prosthesis of synovial fluid. To assess the clinical effectiveness of using a visual analogue scale of pain (VAS) and a questionnaire for patients with back problems in Oswestry. The dynamic assessment was performed within the time frame to 30 months after surgery. The study found that the puncture facet joints with intra-articular injections of the prosthesis of the synovial fluid - «fasetoplasty¼ is an effective minimally invasive treatment for facet syndrome, caused by degenerative-dystrophic lesions facet joints of lumbar spine, allowing early and late postoperative periods to conduct sustained a significant decrease in the level of pain and improve the quality of life in a group of elderly patients.

Lordosis manoeuvre in the diagnosis of lumbar facet syndrome. / Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar.

UNLABELLED: In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HYPOTHESIS: The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies MATERIALS AND METHODS: A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. EXCLUSION CRITERIA: Deformity and instability. using a physical. OBJECTIVE: To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). STATISTICS: R package software. RESULTS: The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. CONCLUSIONS: A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.

Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty.

We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study).

Third-degree burn from cooled radiofrequency ablation of medial branch nerves for treatment of thoracic facet syndrome.

Radiofrequency ablation of medial branch nerves is considered a safe and effective treatment for chronic facet joint pain in the cervical, thoracic, and lumbosacral spine. Cooled radiofrequency ablation (C-RFA) is gaining popularity over conventional thermal radiofrequency ablation (RFA) in pain management. However, complications of C-RFA have not been reported in the literature. We present a first report of third-degree skin burn resulting from C-RFA electrode use for the treatment of facet syndrome. A 61-year-old woman (BMI of 21.8 kg/m(2) ) with thoracic facet syndrome underwent C-RFA of the T1-4 medial branch nerves (Thoracool System, Baylis Medical Company, Montreal, QC, Canada). Lesioning at the superior-lateral aspect of the thoracic transverse processes at each level was performed. During lesioning of the T2 MBN on the T3 transverse process, skin blanching 15 mm in diameter was noted around the introducer needle with patient complaints of severe, localized pain. Postprocedurally the skin injury at this level worsened in appearance, with a 20 mm × 4 mm skin defect, which took nearly 5 months to heal. With C-RFA, internally cooled electrodes are capable of creating large volume spherical lesions, a size advantage over conventional RFA. Although C-RFA lesion size may overcome the anatomic variability of target nerve location and potentially improve pain outcomes, added vigilance is required in thin patients and in anatomic regions of minimal subcutaneous tissue between the lesion target and the dermis. Skin burns at the site of the RF electrode are a potential risk under such conditions.

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.