scholarly journals Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

2020 ◽  
Vol 17 (21) ◽  
pp. 7932
Author(s):  
Gordon E. Lawson ◽  
Paul S. Nolet ◽  
Adam R. Little ◽  
Anit Bhattacharyya ◽  
Vivian Wang ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Medical Documentation ◽  
Medial Branch ◽  
Medical Evidence ◽  
Traffic Crash ◽  
Spine Pain ◽  
Objective Evidence ◽  
Post Traumatic ◽  
Facet Joint Pain

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.

Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain

Spine ◽  
2018 ◽  
Vol 43 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Dong Gyu Lee ◽  
Sang Ho Ahn ◽  
Yun Woo Cho ◽  
Kyung Hee Do ◽  
Sang Gyu Kwak ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Steroid Injection ◽  
Medial Branch ◽  
Medial Branch Block ◽  
Facet Joint Pain

The response to radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints

2018 ◽  
Vol 18 (4) ◽  
pp. 747-753
Author(s):  
Olav Rohof ◽  
Chee Kean Chen
Keyword(s):  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Controlled Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Medial Branch ◽  
Pain Disability Index ◽  
The Mean ◽  
Facet Joint Pain

AbstractBackground and aimsThe evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain.MethodsThis is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015. The outcome measures were mean changes in Numeral Rating Scale (NRS) and Pain Disability Index (PDI).ResultsThere were 71 patients with complete data available for analysis. The mean age of the patients was 57.9±11.2 years. The mean duration of pain was 23±10.5 months. The majority of patients (82%) had pain reduction of more than 50% at 12 months after bipolar RF neurotomy. The NRS decreased significantly from baseline of 7.75±1.25 to 2.86±1.53 at 3 months and 2.82±1.29 at 12 months post-procedure (p<0.001.p<0.001, respectively). The PDI improved significantly from 40.92±12.22 to 24.15±9.79,p<0.05). There were no serious adverse effects or complications of the procedure reported in this study.ConclusionsBipolar RF neurotomy of thoracic medial branch is associated with a significant reduction in thoracic facet joint pain. The promising findings from this case series merit further assessment with prospective, randomized controlled trial which will produce a more reliable and accurate finding for its clinical applications.

scholarly journals Systematic Review of Diagnostic Utility and Therapeutic Effectiveness of Thoracic Facet Joint Interventions

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 611-629
Author(s):  
Sairam Atluri
Keyword(s):  
Back Pain ◽  
Local Anesthetic ◽  
Joint Pain ◽  
Facet Joint ◽  
Therapeutic Interventions ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Level I ◽  
Facet Joint Pain ◽  
Facet Joint Interventions

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of the patients based on the responses to controlled diagnostic blocks. Systematic reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain, moderate evidence for therapeutic thoracic medial branch blocks, and limited evidence for radiofrequency neurotomy of therapeutic facet joint nerves. Objectives: To determine the clinical utility of diagnostic and therapeutic thoracic facet joint interventions in diagnosing and managing chronic upper back and mid back pain. Study Design: Systematic review of diagnostic and therapeutic thoracic facet joint interventions. Methods: Review of the literature for utility of facet joint interventions in diagnosing and managing facet joint pain was performed according to the Agency for Healthcare Research and Quality (AHRQ) criteria for diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by United States Preventive Services Task Force (USPSTF) for therapeutic interventions. Recommendations were based on the criteria developed by Guyatt et al. Data sources included relevant literature of the English language identified through searches of Medline and EMBASE from 1966 to July 2008 and manual searches of bibliographies of known primary and review articles. Results of the analysis were performed for diagnostic and therapeutic interventions separately. Outcome Measures: For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks. For therapeutic interventions, the primary outcome measure was pain relief (short-term relief = up to 6 months and long-term relief > 6 months) with secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: Based on the controlled comparative local anesthetic blocks, the evidence for the diagnosis of thoracic facet joint pain is Level I or II-1. The evidence for therapeutic thoracic medial branch blocks is Level I or II-1. The recommendation is IA or 1B/strong for diagnostic and therapeutic medial branch blocks. Conclusion: The evidence for the diagnosis of thoracic facet joint pain with controlled comparative local anesthetic blocks is Level I or II-1. The evidence for therapeutic facet joint interventions is Level I or II-1 for medial branch blocks. Recommendation is 1A or 1B/strong for diagnostic and therapeutic medial branch blocks. Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, therapeutic thoracic medial branch blocks, thoracic radiofrequency neurotomy, thoracic intraarticular facet joint injections

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.

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 Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

Clinics ◽  
2014 ◽  
Vol 69 (8) ◽  
pp. 529-534 ◽  
Author(s):  
ID Rocha ◽  
AF Cristante ◽  
RM Marcon ◽  
RP Oliveira ◽  
OB Letaif ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Lumbar Facet Joint ◽  
Facet Joint Pain ◽  
Lumbar Facet

Cervical Medial Branch Blocks for Chronic Cervical Facet Joint Pain

Spine ◽  
2008 ◽  
Vol 33 (17) ◽  
pp. 1813-1820 ◽  
Author(s):  
Laxmaiah Manchikanti ◽  
Vijay Singh ◽  
Frank J. E. Falco ◽  
Kimberly M. Cash ◽  
Bert Fellows
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Facet Joint Pain ◽  
Cervical Facet ◽  
Cervical Facet Joint
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