scholarly journals Clinical Diagnosis Scale for Lumbar Pain of Facet Origin: Systematic Review of Literature and Pilot Study

Neurosurgery ◽  
2020 ◽  
Vol 67 (Supplement_1) ◽  
Author(s):  
Juan Carlos G Vega ◽  
Acevedo Gonzalez ◽  
Juan Carlos
Keyword(s):  
Systematic Review ◽  
Clinical Diagnosis ◽  
Facet Joint ◽  
Phase 1 ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Lumbar Pain ◽  
Preoperative Pain ◽  
Facet Syndrome ◽  
Lumbar Facet

Abstract INTRODUCTION Lumbar pain affects between 60–90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. METHODS The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature, Phase 2, a list of signs and symptoms, phase 3, submitted to a committee of experts to discriminate the most significant signs and symptoms, Phase 4, recollection of patients and the evaluation questionnaire was applied, phase 5, selective facet block and subsequent postoperative clinical control, phase 6, propose a clinical scale of diagnosis scale RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms and 3 signs. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.

scholarly journals Clinical Diagnosis Scale for Pain Lumbar of Facet Origin: Systematic Review of Literature and Pilot Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Juan C Gomez Vega ◽  
Juan C Acevedo Gonzalez
Keyword(s):  
Systematic Review ◽  
Clinical Diagnosis ◽  
Facet Joint ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Transverse Process ◽  
Lumbar Pain ◽  
Preoperative Pain ◽  
Facet Syndrome ◽  
Lumbar Facet

Abstract INTRODUCTION Lumbar pain affects between 60% and 90% of people. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays, the pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this study is to propose a clinical diagnostic scale for lumbar facet syndrome. METHODS A systematic review was made on signs and symptoms of lumbar facet pain, these were then submitted to the consideration of a group of experts and the most important ones were extracted, a questionnaire was later made with the most important signs and symptoms, which were applied to a group of patients subjected to percutaneous blockade for facet pain, and, finally, the pre- and postsurgical results were related to the positive signs, proposing a clinical scale of diagnostic evaluation. RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome, which were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. A total of 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60 ± 11.5 yr, analogous visual scale of preoperative pain of 8/10, and postoperative of 1.7/10. The 3 signs and 3 symptoms most frequently found included in a diagnostic scale were as follows: (symptoms) (1) axial or bilateral axial lumbar pain, (2) improvement with rest, and (3) absence of root pattern, which may have a pseudoradicular pattern; however, the pain is more lumbar than pain in the leg; and (signs) (1) Kemp sign, (2) pain induced in the joint or transverse process, and (3) facet stress sign or Acevedo sign. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. A few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.

scholarly journals Is Bisphosphonate-Related Osteonecrosis of the Jaw an Infection? A Histological and Microbiological Ten-Year Summary

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
A. M. Hinson ◽  
C. W. Smith ◽  
E. R. Siegel ◽  
B. C. Stack
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
Large Scale ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Osteonecrosis Of The Jaw ◽  
Multifactorial Disease ◽  
Clinical Signs And Symptoms ◽  
Surgical Treatments

The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.

Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy

2008 ◽  
Vol 21 (03) ◽  
pp. 285-293 ◽  
Author(s):  
N. Suwankong ◽  
G. Voorhout ◽  
A. de Boer ◽  
H. Hazewinkel ◽  
B. Meij
Keyword(s):  
Medical Records ◽  
Joint Angle ◽  
Facet Joint ◽  
Cauda Equina ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Lumbar Pain ◽  
German Shepherd ◽  
Disc Protrusion ◽  
German Shepherd Dog

SummaryThe medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.

scholarly journals Prognostic factors in low back pain individuals undergoing steroid and anaesthetic intra-articular facet joint infiltration: a protocol for a prospective, longitudinal, cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026903
Author(s):  
João Carlos Rodrigues ◽  
Arthur Werner Poetscher ◽  
Mario Lenza ◽  
Alberto Ofenhejm Gotfryd ◽  
Délio Eulálio Martins Filho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Facet Joint ◽  
Joint Inflammation ◽  
Lumbar Pain ◽  
Life Questionnaire ◽  
Pain Disability ◽  
Informed Consent Form ◽  
Facet Syndrome ◽  
Prospective Longitudinal

IntroductionLumbar pain of facet origin is a common problem worldwide. For those patients not responding to traditional treatment, one approach may be intra-articular infiltration of corticoid and anaesthetic. However, despite the increasing demand for this procedure, no consensus exists regarding its therapeutic value. The selection of eligible participants may be a determining factor since only those with an inflammatory process will benefit from the use of corticosteroids. This study aims to identify differences in disability, pain and quality of life scores in individuals with and without facet joint inflammation who were diagnosed using MRI.Method and analysisThis prospective cohort will include individuals older than 18 years with a clinical diagnosis of facet syndrome who underwent intra-articular infiltration. Changes in scores of pain, disability and quality of life questionnaires at 1, 3, 6 and 12 months of follow-up compared with baseline will be analysed. An MRI examination performed before infiltration will help to distinguish between exposed (with inflammation) and non-exposed (non-inflammation) groups with facet syndrome. The primary outcome will be the disability questionnaire (Roland Morris), and the secondary outcomes will be the score questionnaires for pain (Visual Analogue Scale), quality of life (EuroQol Quality of Life Questionnaire) and disability (Oswestry).Ethics and disseminationThe Internal Review Board approved this study, which started only after the approval number (5291417.0.0000.0071) was received. All recruited participants will receive a verbal explanation about the purpose of the study, and their decision to participate will be free and voluntary. All participants enrolled in the study will provide a signed informed consent form including confidentiality terms. The results obtained in this study will be presented at national and international conferences and published in peer-reviewed scientific journals to disseminate the knowledge.Trials registration numberNCT03304730; Pre-results.

Posterior Branches of Lumbar Spinal Nerves – part II: Lumbar Facet Syndrome – Pathomechanism, Symptomatology and Diagnostic Work-up

2017 ◽  
Vol 19 (2) ◽  
pp. 101-109 ◽  
Author(s):  
Katarzyna Kozera ◽  
Bogdan Ciszek ◽  
Paweł Szaro
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Spinal Nerves ◽  
Lower Lumbar Spine ◽  
Facet Syndrome ◽  
Lumbar Spinal ◽  
Lumbar Facet

Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Low back pain caused by facet joint pathology may be triggered e.g. by simple activities, such as body rotations, unnatural positions, lifting heavy weights or excessive bending as well as chronic overloading with spinal hyperextension. Pain usually presents at the level of the lumbosacral junction (L 5 -S 1 ) and in the lower lumbar spine (L 4-5 , L 3-4 ). In the absence of specific diagnostic criteria, it is only possible to conclude that patients display tenderness at the level of the affected facet joint and that the pain is triggered by extension. Differential diagnosis for low back pain is difficult, since the pain may originate from various structures. The most reliable method of identifying Lumbar Facet Syndrome has been found to be a positive response to an analgesic procedure in the form of a block of the medial branch or intraarticular injection. There appear to be good grounds for conducting further studies and developing unequivocal diagnostic tests.

scholarly journals Sensory mapping of lumbar facet joint pain: a feasibility study

2019 ◽  
pp. 204946371988689
Author(s):  
Saravanakumar Kanakarajan ◽  
Kasun Fernando ◽  
Sudhindra Dharmavaram ◽  
Helen F Galley
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Detection Threshold ◽  
University Teaching ◽  
Lumbar Pain ◽  
Lumbar Facet Joint ◽  
Sensory Mapping ◽  
Facet Joint Pain ◽  
Painful Area ◽  
Lumbar Facet

Objective: To evaluate the feasibility of sensory mapping of lumbar facet joint pain in patients scheduled to undergo radiofrequency (RF) denervation. Design: Prospective cohort study. Setting: University teaching hospital. Subjects: A total of 15 participants listed for RF denervation of lumbar facet joint. Method: After written informed consent, participants were recruited to the study. Participants completed a pain diagram prior to their procedure. After successful image-guided placement of RF cannulas, the sensory detection threshold using 50 Hz stimulation was obtained, followed by application of suprathreshold stimulation. Participants mapped their stimulated area in comparison to their pre-procedure pain diagram. Results: All 15 participants had previously undergone diagnostic blocks. All participants were able to report either pain or paraesthesia during suprathreshold stimulation. In total, 14 out of 15 participants reported complete coverage of their usual painful area with suprathreshold stimulation of nerves scheduled for RF denervation. In one of the participants, an area of upper lumbar pain was not covered during suprathreshold stimulation. Nearly two-thirds of the participants (n = 9), reported either pain or paraesthesia, outside their normal painful area during suprathreshold stimulation. A total of 71 nerves were scheduled for RF denervation. Sensory electrical stimulation was successfully achieved in 68 out of 71 nerves (96%). The average sensory detection threshold was found to be 0.3 V while the suprathreshold stimulation was 0.6 V. Conclusion: Lumbar facet joint pain can be mapped using suprathreshold sensory stimulation, which has the potential to introduce objectivity during RF denervation.

scholarly journals Regenerative Endodontic Procedures, Disinfectants and Outcomes: A Systematic Review

2020 ◽  
Vol 9 (4) ◽  
pp. 65-84
Author(s):  
Adam S. Kharchi ◽  
Nara Tagiyeva-Milne ◽  
Shalini Kanagasingam
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Permanent Teeth ◽  
Randomised Control Trial ◽  
Eligibility Criteria ◽  
High Quality Research ◽  
Patient Reported ◽  
Secondary Outcomes

Aims: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. Methods: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). Main findings: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. Principle conclusions: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.

Medically important trombiculids: a systematic review of the global distribution and clinical consequences of their bites

2021 ◽  
Vol 5 (2) ◽  
pp. 67-76
Author(s):  
Julián F. Porras-Villamil ◽  
Mario Javier-Olivera
Keyword(s):  
Systematic Review ◽  
Human Health ◽  
Case Reports ◽  
Clinical Signs ◽  
Case Series ◽  
Clinical Importance ◽  
Signs And Symptoms ◽  
Publication Date ◽  
Rickettsial Infections ◽  
Clinical Consequences

Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Methods: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly.

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