Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Cohen SP, Williams KA, Kurihara C, et al. Anesthesiology 2010;113(2):395–405

2011 ◽  
Vol 11 (3) ◽  
pp. 251-251 ◽  
Keyword(s):  
Cost Effectiveness ◽  
Nerve Block ◽  
Facet Joint ◽  
Effectiveness Study ◽  
Medial Branch ◽  
Comparative Cost ◽  
Radiofrequency Denervation ◽  
Lumbar Facet ◽  
Cost Effectiveness Study

Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain

2007 ◽  
Vol 106 (3) ◽  
pp. 591-614 ◽  
Author(s):  
Steven P. Cohen ◽  
Srinivasa N. Raja
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Medial Branch ◽  
Systematic Analysis ◽  
Zygapophysial Joint ◽  
Radiofrequency Denervation ◽  
Facet Joint Pain ◽  
Lumbar Facet

Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. The onset of lumbar facet joint pain is usually insidious, with predisposing factors including spondylolisthesis, degenerative disc pathology, and old age. Despite previous reports of a "facet syndrome," the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article, the authors provide a comprehensive review of the anatomy, biomechanics, and function of the lumbar zygapophysial joints, along with a systematic analysis of the diagnosis and treatment of facet joint pain.

Ultrasound-guided Lumbar Facet Nerve Block

2004 ◽  
Vol 101 (5) ◽  
pp. 1195-1200 ◽  
Author(s):  
Manfred Greher ◽  
Lukas Kirchmair ◽  
Birgit Enna ◽  
Peter Kovacs ◽  
Burkhard Gustorff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Medium ◽  
Nerve Block ◽  
Facet Joint ◽  
Target Point ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Ultrasound Technique ◽  
Computed Tomography Scans ◽  
Lumbar Facet

Background Lumbar facet nerve (medial branch) blocks are often used to diagnose facet joint-mediated pain. The authors recently described a new ultrasound-guided methodology. The current study determines its accuracy using computed tomography scan controls. Methods Fifty bilateral ultrasound-guided approaches to the lumbar facet nerves were performed in five embalmed cadavers. The target point was the groove at the cephalad margin of the transverse (or costal) process L1-L5 (medial branch T12-L4) adjacent to the superior articular process. Axial transverse computed tomography scans, with and without 1 ml contrast dye, followed to evaluate needle positions and spread of contrast medium. Results Forty-five of 50 needle tips were located at the exact target point. The remaining 5 were within 5 mm of the target. In 47 of 50 cases, the applied contrast dye reached the groove where the nerve is located, corresponding to a simulated block success rate of 94% (95% confidence interval, 84-98%). Seven of 50 cases showed paraforaminal spread, 5 of 50 showed epidural spread, and 2 of 50 showed intravascular spread. Despite the aberrant distribution, all of these approaches were successful, as indicated by contrast dye at the target point. Abnormal contrast spread was equally distributed among all lumbar levels. Contrast traces along the needle channels were frequently observed. Conclusions : The computed tomography scans confirm that our ultrasound technique for lumbar facet nerve block is highly accurate for the target at all five lumbar transverse processes (medial branches T12-L4). Aberrant contrast medium spread is comparable to that of the classic fluoroscopy-guided method.

Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study

2020 ◽  
Vol 24 (3) ◽  
pp. 247-254 ◽  
Author(s):  
Y. Quijano ◽  
J. Nuñez-Alfonsel ◽  
B. Ielpo ◽  
V. Ferri ◽  
R. Caruso ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Cost Effectiveness ◽  
Effectiveness Study ◽  
Comparative Cost ◽  
Cost Effectiveness Study

A Comparative Cost-Effectiveness Study of Two Treatment Modalities for Ragweed Hay Fever

1989 ◽  
Vol 3 (2) ◽  
pp. 99-104 ◽  
Author(s):  
Frederick E. Leickly ◽  
Dolores Sears-Ewald ◽  
Dennis R. Ownby
Keyword(s):  
Allergic Rhinitis ◽  
Cost Effectiveness ◽  
Low Dose ◽  
Hay Fever ◽  
Treatment Modalities ◽  
Effectiveness Study ◽  
Cost Of Treatment ◽  
Comparative Cost ◽  
The Cost ◽  
Cost Effectiveness Study

The cost of treatment for ragweed hay fever can vary considerably. The newer classes of antihistamines are purported to be effective and without major side effects, but they are costly. This study compared the cost-effectiveness of terfenadine and chlorpheniramine/pseudoephedrine. We found that the maximum use of a low dose of chlorpheniramine/pseudoephedrine was effective and without major daytime sedation and should be considered when treatment for ragweed-induced allergic rhinitis is begun.

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