Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptom...Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.展开更多
AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodol...AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.展开更多
AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain...AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.展开更多
Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: Th...Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure;85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique;CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.展开更多
目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT...目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT)、Cochrane Database of Systematic Reviews(CDSR)等数据库,检索射频消融治疗SIJ/LFJ的随机对照研究,进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入9篇随机对照文献和560例患者。Meta分析显示,射频消融可提高SIJ/LFJ患者治疗的临床有效率(OR=16.41,95%CI=2.18~123.28,P=0.007)和优良率(OR=11.94,95%CI=5.02~28.36,P<0.001);射频消融可降低SIJ/LFJ患者的治疗后1周时VAS/NRS评分(WMD=-0.50,95%CI=-0.61~-0.39,P<0.001)、治疗后3个月时VAS/NRS评分(WMD=-1.37,95%CI=-1.82~-0.91,P<0.001)、治疗后6个月时VAS/NRS评分(WMD=-2.25,95%CI=-3.75~-0.75,P=0.003)、治疗后1个月时ODI指数(WMD=-14.86,95%CI=-28.73~-0.99,P=0.04)、治疗后3个月时ODI指数(WMD=-6.00,95%CI=-10.74~-6.53,P=0.01);射频消融对治疗后1 d时VAS/NRS评分(WMD=-0.06,95%CI=-0.35~0.23,P=0.67)、治疗后1个月时VAS/NRS评分(WMD=-0.85,95%CI=-1.91~0.21,P=0.12)和不良反应(OR=0.25,95%CI=0.05~1.29,P=0.10)无显著影响。结论射频消融治疗SIJ/LFJ安全有效。展开更多
文摘Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.
文摘AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
文摘AIM: To investigate if the clinical outcome of intraarticular lumbar facet joint injections is affected by the therapist's attitude. METHODS: A total of 40 patients with facet jointassociated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group(EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group(CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion.
文摘Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure;85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique;CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.
文摘目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT)、Cochrane Database of Systematic Reviews(CDSR)等数据库,检索射频消融治疗SIJ/LFJ的随机对照研究,进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入9篇随机对照文献和560例患者。Meta分析显示,射频消融可提高SIJ/LFJ患者治疗的临床有效率(OR=16.41,95%CI=2.18~123.28,P=0.007)和优良率(OR=11.94,95%CI=5.02~28.36,P<0.001);射频消融可降低SIJ/LFJ患者的治疗后1周时VAS/NRS评分(WMD=-0.50,95%CI=-0.61~-0.39,P<0.001)、治疗后3个月时VAS/NRS评分(WMD=-1.37,95%CI=-1.82~-0.91,P<0.001)、治疗后6个月时VAS/NRS评分(WMD=-2.25,95%CI=-3.75~-0.75,P=0.003)、治疗后1个月时ODI指数(WMD=-14.86,95%CI=-28.73~-0.99,P=0.04)、治疗后3个月时ODI指数(WMD=-6.00,95%CI=-10.74~-6.53,P=0.01);射频消融对治疗后1 d时VAS/NRS评分(WMD=-0.06,95%CI=-0.35~0.23,P=0.67)、治疗后1个月时VAS/NRS评分(WMD=-0.85,95%CI=-1.91~0.21,P=0.12)和不良反应(OR=0.25,95%CI=0.05~1.29,P=0.10)无显著影响。结论射频消融治疗SIJ/LFJ安全有效。
