Medial branch blocks and facet joint injections as predictors of successful radiofrequency ablation

2011 ◽  
Vol 15 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Elias Veizi ◽  
Ali Mchaourab
Keyword(s):  
Radiofrequency Ablation ◽  
Facet Joint ◽  
Medial Branch ◽  
Joint Injections

Predictors of response to medial branch block, radiofrequency ablation or facet joint injections: a retrospective study

2020 ◽  
Author(s):  
Saba Javed ◽  
Jordan Chen ◽  
Billy Huh
Keyword(s):  
Radiofrequency Ablation ◽  
Facet Joint ◽  
Demographic Data ◽  
Patient Characteristics ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Predictors Of Response ◽  
Medial Branch Block ◽  
Lumbar Facet ◽  
Joint Injections

Aim: Low back pain is a leading cause of patient disability in the USA. Our goal was to determine association between patient characteristics and their response to lumbar medial branch block, radiofrequency ablation of medial nerves or lumbar facet joint injections. Materials & methods: Medical records for the first 100 patients who underwent lumbar medial branch block, radiofrequency ablation of lumbar medial nerves or lumbar facet joint injections between 1 September 2019 and 31 March 2020 were reviewed and demographic data were recorded. Results: At the 3-month post-procedure visit, positive responders were significantly more likely to be non obese patients (BMI <30) and those with pain <5-years. Conclusion: Obesity and chronicity of pain certainly are found to be predictors of response to the above mentioned procedures.

CyberKnife rhizotomy for facetogenic back pain: a pilot study

2007 ◽  
Vol 23 (6) ◽  
pp. E1 ◽  
Author(s):  
Gordon Li ◽  
Chirag Patil ◽  
John R. Adler ◽  
Shivanand P. Lad ◽  
Scott G. Soltys ◽  
...  
Keyword(s):  
Back Pain ◽  
Radiofrequency Ablation ◽  
Facet Joint ◽  
Late Onset ◽  
Target Volume ◽  
Facet Joints ◽  
Positron Emission ◽  
Cyberknife Radiosurgery ◽  
Joint Injections

Object By targeting the medial branches of the dorsal rami, radiofrequency ablation and facet joint injections can provide temporary amelioration of facet joint–producing (or facetogenic) back pain. The authors used CyberKnife radiosurgery to denervate affected facet joints with the goal of obtaining a less invasive yet more thorough and durable antinociceptive rhizotomy. Methods Patients with refractory low-back pain, in whom symptoms are temporarily resolved by facet joint injections, were eligible. The patients were required to exhibit positron emission tomography–positive findings at the affected levels. Radiosurgical rhizotomy, targeting the facet joint, was performed in a single session with a marginal prescription dose of 40 Gy and a maximal dose of 60 Gy. Results Seven facet joints in 5 patients with presumptive facetogenic back pain underwent CyberKnife lesioning. The median follow-up was 9.8 months (range 3–16 months). The mean planning target volume was 1.7 cm3 (range 0.9–2.7 cm3). A dose of 40 Gy was prescribed to a mean isodose line of 79% (range 75–80%). Within 1 month of radiosurgery, improvement in pain was observed in 3 of the 5 patients with durable responses at 16, 12, and 6 months, respectively, of follow-up. Two patients, after 12 and 3 months of follow-up, have neither improved nor worsened. No patient has experienced acute or late-onset toxicity. Conclusions These preliminary results suggest that CyberKnife radiosurgery could be a safe, effective, and non-invasive alternative to radiofrequency ablation for managing facetogenic back pain. No patient suffered recurrent symptoms after radiosurgery. It is not yet known whether pain relief due to such lesions will be more durable than that produced by alternative procedures. A larger series of patients with long-term follow-up is ongoing.

scholarly journals Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

2019 ◽  
Vol 44 (3) ◽  
pp. 389-397 ◽  
Author(s):  
Zachary L McCormick ◽  
Heejung Choi ◽  
Rajiv Reddy ◽  
Raafay H Syed ◽  
Meghan Bhave ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Success Rate ◽  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Prospective Trial ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

Background and objectivesNo previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.MethodsIn this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.ResultsForty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).ConclusionsWhen using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.Trial registration numberNCT02478437.

Cervical Intra-Articular Facet Injection: Computed Tomography

2016 ◽  
Author(s):  
Amaresh Vydyanathan ◽  
Karina Gritsenko ◽  
Samer N. Narouze ◽  
Allan L. Brook
Keyword(s):  
Pain Relief ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Medial Branch ◽  
Nerve Blocks ◽  
Articular Facet ◽  
Short And Long Term ◽  
Joint Injections

Intra-articular facet joint injections commonly refer to the injection of a contrast media and local anesthetic solution, with or without corticosteroids, directly into the facet joint space. The purpose of this procedure is pain relief as well as to establish an etiological diagnosis for surgical interventions such as joint denervation or radiofrequency ablation. Medial branch block, or facet nerve block, refers to injection of local anesthetic and possible corticosteroids along the medial branch nerve supplying the facet joints. Cervical intra-articular and facet nerve block injections are often part of a work-up for general or focal neck pain, headaches, or cervical muscle spasms. There is limited evidence for short- and long-term pain relief with cervical intra-articular facet joint injections. Cervical medial branch nerve blocks with local anesthetics demonstrate moderate evidence for short- and long-term pain relief with repeat interventions, and strong evidence exists for long-term pain relief following cervical radiofrequency neurotomy.

Antiplatelet and Anticoagulant Risk for Select Spine Interventions: A Retrospective Cohort

Pain Medicine ◽  
2020 ◽  
Vol 21 (5) ◽  
pp. 910-917
Author(s):  
Reza Ehsanian ◽  
Renee M Rosati ◽  
David J Kennedy ◽  
Byron J Schneider
Keyword(s):  
Epidural Hematoma ◽  
Facet Joint ◽  
Anticoagulant Effect ◽  
Bleeding Complications ◽  
Medial Branch ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Clinical Encounters ◽  
Epidural Steroid ◽  
Joint Injections

Abstract Objectives To identify significant bleeding complications following spinal interventions in patients taking medications with antiplatelet or anticoagulation effect. Design Retrospective chart review of a 12-month period. Setting Outpatient academic medical practice. Interventions Injections during outpatient interventional spine clinical encounters, including 14 cervical transforaminal epidural steroid injections, 26 cervical medial branch blocks, seven cervical radiofrequency neurotomies, three cervical facet joint injections, 88 lumbar transforaminal epidural steroid injections, 66 lumbosacral medial branch blocks, 18 lumbosacral radiofrequency neurotomies, 13 lumbar facet joint injections, one caudal epidural steroid injection, 11 sacral transforaminal epidural steroid injections, and 32 sacroiliac joint injections. Main Outcome Measure Epidural hematoma or other serious bleeding. Results In this cohort of 275 consecutive encounters with available records in which patients underwent a spinal injection while continuing medications with antiplatelet or anticoagulant effect, zero of the 275 clinical encounters (0%, 95% confidence interval = 0–1.4%) resulted in epidural hematoma or other serious bleeding. For antiplatelet medication, nonsteroidal anti-inflammatory drugs were continued in 102 procedures, aspirin in 142, clopidogrel in 21, and meloxicam and/or Celebrex in 81; for anticoagulation medication, warfarin was continued in four procedures, apixaban in six, dabigatran in one, and fondaparinux in two. Of note, one patient suffered a deep vein thrombosis, which was identified at two-week follow-up despite continuing aspirin therapy. Conclusions This cohort adds to the growing evidence that the risk of serious bleeding complications from select spine interventions while continuing medications with antiplatelet or anticoagulant effect appears low.

scholarly journals Systematic Review Of Diagnostic Utility Of Facet (Zygapophysial) Joint Injections In Chronic Spinal Pain: An Update

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 213-228
Author(s):  
Nalini Sehgal
Keyword(s):  
Low Back Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Spinal Pain ◽  
Medial Branch ◽  
Low Back ◽  
Facet Joints ◽  
Facet Joint Pain ◽  
Joint Injections ◽  
Chronic Spinal Pain

Background: A 2-year review of literature from October 2004 to December 2006 was completed to update current scientific evidence on diagnostic utility of facet joint injections. Diagnostic injections are employed to diagnose facet joint pain because available techniques cannot identify the pain generating structure in patients with chronic spinal pain. There is no physical examination technique, laboratory test, or imaging modality that can precisely identify the spinal structure causing pain, distinguish the culprit from a variety of potential targets, and predict response to a therapeutic intervention. Zygapophysial joint injections, commonly called facet injections (intra-articular joint injections and medial branch blocks) are local anesthetic injections of the facet joint or its nerve supply. These are diagnostic procedures used to determine if pain is arising from facet joints, distinguish painful from nonpainful joints and prognosticate response to therapeutic facet joint interventions. Diagnostic injections must meet the cardinal features of a diagnostic test i.e., accuracy, safety, and reproducibility. Accuracy is based on comparison with a “gold standard” to confirm presence or absence of a disease. There is, however, no available gold standard to measure presence or absence of pain. Hence, there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections. Objectives: Evaluate and update available evidence (2004 to 2006) relating to clinical utility of facet joint injections (intraarticular and medial branch blocks) in diagnosing chronic spinal pain of facet joint origin. Study Design: Review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing facet joint pain according to Agency for Healthcare Research and Quality (AHRQ) and Quality Assessment Studies of Diagnostic Accuracy (QUADAS) criteria. The level of evidence was classified as conclusive (Level I), strong (Level II), moderate (Level III), or limited (Level IV). Methods: Computerized database search (2004 to 2006) of PUBMED, EMBASE, CINAHL, and Web of Knowledge was conducted to identify studies on facet joint pain and diagnostic interventions. Abstracts, reviews, book chapters, case reports, studies based on single blocks or blocks without radiologic control, and studies describing techniques were excluded. Prospective studies were given priority over retrospective studies. Results: There is no change in the strength of evidence for facet joint diagnostic injections. There is strong evidence for controlled comparative local anesthetic facet joint injections or medial branch blocks in the diagnosis of neck and low back pain and moderate evidence in the diagnosis of pain arising from thoracic facet joints. Conclusion: The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joints (medial branch or dorsal ramus) are reproducible, reasonably accurate and safe. The sensitivity, specificity, false-positive rates, and predictive values of these diagnostic tests for neck and low back pain have been validated and reproduced in multiple studies. Key words: Chronic spinal pain, neck pain, low back pain, cervical facet joint, thoracic facet joint, lumbar facet joint, zygapophyseal joint, medial branch block, intraarticular injection

scholarly journals A Critical Look at the Data Supporting Ultrasound Guided Cervical Medial Branch Blocks

2020 ◽  
Author(s):  
Meredith Barad
Keyword(s):  
Cervical Spine ◽  
Facet Joint ◽  
Meta Analysis ◽  
Current Evidence ◽  
Medial Branch ◽  
Spine Injections ◽  
American Society ◽  
Cervical Facet ◽  
Cervical Facet Joint ◽  
Joint Injections

According to guidelines published by the American Society of Interventional Pain Physicians in 2013 ‎1, ‎2, the current evidence for cervical facet joint injections is fair. Yet the volume of these procedures continues to rise ‎3. There is a need for a more critical appraisal of the benefit, technique and adverse effects associated with cervical spine injections. The systematic review and meta-analysis by Paredes et al ‎4 seeks to better assess the evidence for use of ultrasound (US) guidance with cervical medial branch blocks. This article is also a response to a recently published critique by Schneider et al ‎5 raising concerns about the paucity of evidence evaluating the safety, accuracy, and effectiveness of US-guided cervical spine procedures.

scholarly journals A Systematic Review of Therapeutic Facet Joint Interventions in Chronic Spinal Pain

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 229-253
Author(s):  
Mark V. Boswell
Keyword(s):  
Pain Relief ◽  
Facet Joint ◽  
Spinal Pain ◽  
Medial Branch ◽  
Short Term ◽  
Radiofrequency Neurotomy ◽  
Short And Long Term ◽  
Facet Joint Interventions ◽  
Joint Injections

Background: Facet joints are considered to be a common source of chronic spinal pain. Facet joint interventions, including intraarticular injections, medial branch nerve blocks, and neurotomy (radiofrequency and cryoneurolysis) are used to manage chronic facet-mediated spinal pain. A systematic review of therapeutic facet interventions published in January 2005, concluded that facet interventions were variably effective for short-term and long-term relief of facet joint pain. Objective: To provide an updated evaluation of the effectiveness of 3 types of facet joint interventions in managing chronic spinal pain. Study Design: A systematic review utilizing criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and the Cochrane Musculoskeletal Review Group for randomized trials. Methods: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (November 2004 to December 2006) and manual searches of bibliographies of known primary and review articles within the last 2 years. Results of the analyses were performed for the different modes of facet joint interventions for the cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with these procedures. Outcome Measures: The primary outcome measure was pain relief. For intraarticular facet joint injections and medial branch blocks, short-term pain relief was defined as relief lasting less than 6 weeks and long-term relief as 6 weeks or longer. For medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. Results: For cervical intraarticular facet joint injections, the evidence is limited for short- and long-term pain relief. For lumbar intraarticular facet joint injections, the evidence is moderate for short- and long-term pain relief. For cervical, thoracic, and lumbar medial branch nerve blocks with local anesthetics (with or without steroids), the evidence is moderate for short- and longterm pain relief with repeat interventions. The evidence for pain relief with radiofrequency neurotomy of cervical and lumbar medial branch nerves is moderate for short- and long-term pain relief, and indeterminate for thoracic facet neurotomy. Conclusion: With intraarticular facet joint injections, the evidence for short- and long-term pain relief is limited for cervical pain and moderate for lumbar pain. For medial branch blocks, the evidence is moderate for short- and long-term pain relief. For medial branch neurotomy, the evidence is moderate for short- and long-term pain relief. Key words: Spinal pain, neck pain, low back pain, facet or zygapophysial joints, intraarticular facet joint injections, medial branch blocks, therapeutic medial branch blocks, radiofrequency neurotomy, cryodenervation.

scholarly journals Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

2021 ◽  
pp. rapm-2021-103031
Author(s):  
Robert W Hurley ◽  
Meredith C B Adams ◽  
Meredith Barad ◽  
Arun Bhaskar ◽  
Anuj Bhatia ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Practice ◽  
Radiofrequency Ablation ◽  
Neck Pain ◽  
Working Group ◽  
Selection Criteria ◽  
Medial Branch ◽  
Pain Medicine ◽  
En Bloc ◽  
Joint Injections

BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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