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Tang X, Yuan H, Huang X, Xiao S, Ji Y, Zhou Y, Fu H, Lu J, Wang M, Ma K. Endoscopic Joint Capsule and Articular Process Excision for the Treatment of Lumbar Facet Joint Syndrome: A Retrospective Study. J Pain Res 2024; 17:3187-3196. [PMID: 39371490 PMCID: PMC11453151 DOI: 10.2147/jpr.s471503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024] Open
Abstract
Background Dorsal ramus medial branch radiofrequency ablation is reported to be effective for refractory lumbar facet joint syndrome. However, as nerve fibers can regenerate, the therapeutic effect was reported to be short and last only 6 to 12 months. Previously, we reported a novel endoscopic joint capsule and articular process excision procedure. In that case, a satisfying effect was achieved by removing the culprit hyperplastic articular synovial entrapped in the joint space endoscopically. We presume this treatment is an etiologic treatment and can exert longer-term efficacy. Aim This retrospective clinical trial aimed to elucidate the longer-term efficacy as well as the safety profile of the procedure. Methods This was a retrospective descriptive study. The participants underwent endoscopic joint capsule and articular process excision procedures. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) before the operation, and at 3 months, 6 months, 1 year, and 2 years post-operation were recorded by reviewing medical charts and conducting telephone interviews. Results A total of 234 participants were evaluated in the trial. After participant screening, 13 participants were included in the final analysis. The VAS score was reduced from (median (P25, P75)) 6 (4.5, 6) at pre-operation to 2 (0, 4) at 1-year post-operation and 0 (0, 1) at 2-year pre-operation. The ODI score was reduced from 37.78 (27.09, 59.95) at pre-operation to 8.89 (2.22, 24.34) at 1-year post-operation and 6 (0.02, 11.11) at 2-year post-operation. The difference was statistically significant. Further subgroup analysis demonstrated that a narrowed intervertebral space was a possible relevant factor for poor outcomes. No procedure-related complications were reported. Conclusion Endoscopic joint capsule and articular process excision is an effective and safe procedure for refractory lumbar facet joint syndrome. The effectiveness duration can last up to 1 to 2 years.
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Affiliation(s)
- Xiaoxing Tang
- Department of Radiology, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, People’s Republic of China
| | - Hongjie Yuan
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Xuehua Huang
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Shilin Xiao
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Yun Ji
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Yanjing Zhou
- Department of Radiology, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, People’s Republic of China
| | - Hongbo Fu
- Department of Algology, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, People’s Republic of China
| | - Jingfeng Lu
- Department of Neurosurgery, Haian People’s Hospital, Nantong, Jiangsu Province, People’s Republic of China
| | - Mingkai Wang
- Pharmacy Department, Nantong Elderly Rehabilitation Hospital, Nantong, Jiangsu Province, People’s Republic of China
| | - Ke Ma
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
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Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline. Global Spine J 2024; 14:2124-2154. [PMID: 38321700 PMCID: PMC11418679 DOI: 10.1177/21925682241230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
STUDY DESIGN Systematic review of the literature and subsequent meta-analysis for the development of a new guideline. OBJECTIVES This manuscript summarizes the recommendations from a new clinical guideline published by the German Spine Society. It covers the current evidence on recommendations regarding the indication, test blocks and use of radiofrequency denervation. The guidelines aim is to improve patient care and efficiency of the procedure. METHODS A multidisciplinary working group formulated recommendations based on the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS 20 clinical questions were defined for guideline development, with 87.5% consensus achieved by committee members for one recommendation and 100% consensus for all other topics. Specific questions that were addressed included clinical history, examination and imaging, conservative treatment before injections, diagnostic blocks, the injected medications, the cut-off value in pain-reduction for a diagnostic block as well as the number of blocks, image guidance, the cannula trajectories, the lesion size, stimulation, repeat radiofrequency denervation, sedation, cessation or continuation of anticoagulants, the influence of metal hardware, and ways to mitigate complications. CONCLUSION Radiofrequency (RF) denervation of the spine and the SI joint may provide benefit to well-selected individuals. The recommendations of this guideline are based on very low to moderate quality of evidence as well as professional consensus. The guideline working groups recommend that research efforts in relation to all aspects of management of facet joint pain and SI joint pain should be intensified.
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Affiliation(s)
- Stephan Klessinger
- Neurochirurgie Biberach, Biberach, Germany
- Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Holger Koepp
- Wirbelsäulenzentrum, St Josefs-Hospital, Wiesbaden, Germany
| | - Andreas Kopf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Matti Scholz
- ATOS Orthopädische Klinik Braunfels GmbH & Co KG, Braunfels, Germany
| | | | | | - Martin Vazan
- Wirbelsäulen- und Rückenzentrum Dresden, Praxis für Neurochirurgie, Dresden, Germany
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Qi LN, Sun Y, Shi YT, Yang JH, Yang YR, Qin XZ. Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. Curr Pain Headache Rep 2024; 28:699-708. [PMID: 38526650 DOI: 10.1007/s11916-024-01241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. RECENT FINDINGS There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.
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Affiliation(s)
- Ling Na Qi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Ye Sun
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yu Tong Shi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Jing Han Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yi Ran Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Xiang Zheng Qin
- Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
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Candan B, Gungor S. Traditional versus cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain. Pain Manag 2024; 14:305-314. [PMID: 39076116 PMCID: PMC11340768 DOI: 10.1080/17581869.2024.2377061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024] Open
Abstract
Aim: Traditional radiofrequency ablation (TRFA) effectively treats facet joint-related pain, while water-cooled radiofrequency ablation (CRFA) may offer benefits like larger lesions and easier nerve access. Our goal is to assess the effectiveness of TRFA and CRFA for facet joint-related pain.Materials & methods: This retrospective study included an evaluation of 346 RFA interventions performed on 190 patients suffering from long-term low-back pain. The primary outcome was defined as a decrease of ≥50% of the mean numeric rating scale.Results: The primary outcome was achieved at the first follow-up (FU) for both TRFA and CRFA, with pain relief of 55.2 and 60.5%, respectively. At the second FU, the primary outcome was achieved only in the CRFA group (54.1%), although the TRFA group also showed a good improvement (48.6%). In both groups, pain relief was under 50% during the third FU.Conclusion: Our study indicates that both CRFA and TRFA modalities are effective and safe treatments.
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Affiliation(s)
- Burcu Candan
- Division of Musculoskeletal & Interventional Pain Management, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, NY 10021, USA
| | - Semih Gungor
- Division of Musculoskeletal & Interventional Pain Management, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, NY 10021,USA
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Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Ruiz Santiago F. Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. LA RADIOLOGIA MEDICA 2024; 129:794-806. [PMID: 38512629 DOI: 10.1007/s11547-024-01809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Lumbar facet joint pain (LFJP) is one of the main causes of chronic low back pain (LBP) and can be treated using radiofrequency (RF) sensory denervation. The aim of this work is to analyze the efficacy of RF in LFJP through a systematic review and meta-analysis of randomized controlled trials (RCTs) with placebo control. MATERIALS AND METHODS A systematic search was conducted in the Medline (PubMed), Scopus, Web of Science databases, and the Cochrane Central Register of Controlled Trials (CENTRAL). The variables of interest were pain, functional status, quality of life (QoL), and global perceived effect (GPE) measured at different time intervals: short (< 3 months), medium (> 3 and < 12 months), and long term (> 12 months). RESULTS Eight RCTs with placebo control were included. RF showed significant benefits over placebo in pain relief in the short (MD - 1.01; 95% CI - 1.98 to -0.04; p = 0.04), medium (MD - 1.42; 95% CI - 2.41 to - 0.43; p = 0.005), and long term (MD - 1.12; 95% CI - 1.57 to - 0.68; p < 0.001), as well as improvement in functional disability in the short (SMD - 0.94; 95% CI - 1.73 to - 0.14; p = 0.02) and long term (SMD - 0.74; 95% CI - 1.09 to - 0.39; p < 0.001). No statistically significant differences were observed in QoL or quantitative GPE, but benefits for RF were observed in dichotomous GPE in the medium (OR 0.19; 95% CI 0.07-0.52; p = 0.001) and long term (OR 0.22; 95% CI 0.06-0.78; p = 0.02). Subgroup analyses showed more benefits for RF in LBP < 1 year in the short term and in RCTs that did not require performing an MRI for patient selection. CONCLUSIONS RF demonstrated significant improvement in pain and functionality, but the benefits in terms of QoL and GPE are inconclusive. Future clinical trials should investigate the long-term effects of RF, its impact on quality of life, and define appropriate criteria for patient selection.
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Affiliation(s)
- Antonio Jesús Láinez Ramos-Bossini
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain.
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain.
| | - Paula María Jiménez Gutiérrez
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Anesthesiology, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda. Fuerzas Armadas, 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (IBS.Granada), 18016, Granada, Spain
- Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
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De Salvatore S, Russo F, Vadalà G, Pascarella G, Papalia GF, Ambrosio L, Ruggiero A, Migliorelli S, Carassiti M, Papalia R, Denaro V. Interventional treatments for low back pain due to sacroiliac joint dysfunction: a systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1407-1423. [PMID: 38329572 DOI: 10.1007/s00586-024-08130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This systematic review aimed to report the current evidence in the literature about the efficacy of interventional treatments in the management of low back pain (LBP) due to sacroiliac joint dysfunction. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, Cochrane Library, and CENTRAL bibliographic databases were searched. The search was performed from October to December 2021, and articles from the inception of the database to December 2021 were searched. RESULTS Fourteen studies were included for qualitative synthesis. Five studies used the traditional radiofrequency approach (tRF), five studies used cooled radiofrequency approach (cRF), one study used botulinum toxin (BT), two studies used steroid injection, triamcinolone (TA) and local anesthetics injections, and one study used pulsed radiofrequency (PRF) denervation. Two studies used sham as a comparator. CONCLUSIONS Cooled radiofrequency seems to be the most effective treatment in improving pain and functionality, while intra-articular injections are helpful only as diagnostic tools. However, due to the lack of high-quality studies, it was not possible to draw significant conclusions.
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Affiliation(s)
- Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Department of Orthopedics, Children's Hospital Bambino Gesù, 00165, Palidoro, Rome, Italy
| | - Fabrizio Russo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Gianluca Vadalà
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giuseppe Pascarella
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Giuseppe Francesco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Luca Ambrosio
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Alessandro Ruggiero
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Sabrina Migliorelli
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Massiliano Carassiti
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Bhandal HS, Vu C, Pope JE. IonicRF™: a novel step in technology for radiofrequency ablation treatments. Pain Manag 2024; 14:21-27. [PMID: 35001644 DOI: 10.2217/pmt-2021-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Radiofrequency ablation (RFA) has been utilized since the 1970s to treat various painful conditions. The technology has evolved from its initial use to treat lumbar facet mediated pain with monopolar lesioning to now treat a plethora of chronic pain conditions. This article reviews Abbott Corporation's (IL, USA) IonicRF™ generator. The IonicRF generator utilizes an intelligent power algorithm that improves efficiency and reduces procedure time. The generator also carries a wide range of RFA therapies such as monopolar, bipolar, pulsed or pulsed dose radiofrequency. Additionally, the IonicRF RFA generator is compatible with the Simplicity™ RF probe (Abbott) which allows for efficient and effective denervation of the sacroiliac joint.
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Affiliation(s)
| | - Chau Vu
- Evolve Restorative Center, Santa Rosa, CA 95403, USA
| | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, CA 95403, USA
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Van den Heuvel SAS, Cohen SPC, de Andrès Ares J, Van Boxem K, Kallewaard JW, Van Zundert J. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24:160-176. [PMID: 37640913 DOI: 10.1111/papr.13287] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. METHODS The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. RESULTS There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. CONCLUSIONS Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Sandra A S Van den Heuvel
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Koen Van Boxem
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Amatto A, Burnham T, Teramoto M, Burnham R. The effectiveness and predictive factors of Sacroiliac Joint Radiofrequency Neurotomy success - A retrospective cohort study. INTERVENTIONAL PAIN MEDICINE 2023; 2:100271. [PMID: 39238916 PMCID: PMC11372946 DOI: 10.1016/j.inpm.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2024]
Abstract
Background The Sacroiliac Joint (SIJ) accounts for 10-27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences. Objective To assess the effectiveness and outcome success predictors of SIJ RFN at three months. Design/Methods Data of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire - Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50-79% LBB/LBB, 50-79% IA/LBB, >79% LBB, and 50-79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral). Results Of the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34-11.43; p = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates (p > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ (p = 0.034, 0.020, and 0.002, respectively). Conclusion SIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.
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Affiliation(s)
- Alycia Amatto
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Taylor Burnham
- University of Utah, Department of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Masaru Teramoto
- University of Utah, Department of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Robert Burnham
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Central Alberta Pain and Rehabilitation Institute, Lacombe, AB, Canada
- Vivo Cura Health, Calgary, AB, Canada
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10
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Liu Y, Suvithayasiri S, Kim JS. Comparative Efficacy of Clinical Interventions for Sacroiliac Joint Pain: Systematic Review and Network Meta-analysis With Preliminary Design of Treatment Algorithm. Neurospine 2023; 20:997-1010. [PMID: 37798994 PMCID: PMC10562251 DOI: 10.14245/ns.2346586.293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE We aimed to identify the most effective clinical treatment method for sacroiliac joint (SIJ)-related pain based on the systematic review and network meta-analysis (NMA) to evaluate the comparative efficacy of clinical interventions for sacroiliac joint pain by pooling the randomized controlled trials (RCTs). METHODS Our team conducted a systematic review and NMA of RCTs to determine the most effective clinical treatment for SIJ-related pain. We searched the PubMed (MEDLINE), Web of Science, Cochrane Library, and Scopus databases for RCTs until February 2023. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were followed. Pairwise and network meta-analyses were conducted using a random effects model. RESULTS Based on the search strategy and inclusion criteria, our systematic review and NMA included 9 randomized studies with 652 participants. Research has mainly focused on various radiofrequency sources, but their number is still low. In the network analysis, according to the NMA and mean ranking probabilities for the improvement of pain intensity (PI) and quality of life (QoL), sacroiliac joint fusion and cooled radiofrequency were associated with high treatment rank for improving PI and QoL in patients with sacroiliac joint pain. CONCLUSION This NMA suggest that SIJ fusion and cooled radiofrequency could be potential options for improving the QoL and relieving pain in patients with SIJ-related pain. Comparison studies of outcomes between these 2 procedures with solid methodology and a low risk of bias would be very beneficial to identify the optimal treatment option for this challenging disease.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siravich Suvithayasiri
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Peckham ME, Miller TS, Amrhein TJ, Hirsch JA, Kranz PG. Image-Guided Spine Interventions for Pain: Ongoing Controversies. AJR Am J Roentgenol 2023; 220:736-745. [PMID: 36541595 DOI: 10.2214/ajr.22.28643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An expanding array of image-guided spine interventions have the potential to provide immediate and effective pain relief. Innovations in spine intervention have proceeded rapidly, with clinical adoption of new techniques at times occurring before the development of bodies of evidence to establish efficacy. Although new spine interventions have been evaluated by clinical trials, acceptance of results has been hindered by controversies regarding trial methodology. This article explores controversial aspects of four categories of image-guided interventions for painful conditions: spine interventions for postdural puncture headache resulting from prior lumbar procedures, epidural steroid injections for cervical and lumbar radiculopathy, interventions for facet and sacroiliac joint pain, and vertebral augmentations for compression fractures. For each intervention, we summarize the available literature, with an emphasis on persistent controversies, and discuss how current areas of disagreement and challenge may shape future research and innovation. Despite the ongoing areas of debate regarding various aspects of these procedures, effective treatments continue to emerge and show promise for aiding relief of a range of debilitating conditions.
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Affiliation(s)
- Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 N 1900 E, #1A071, Salt Lake City, UT 84132-2140
| | - Todd S Miller
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Timothy J Amrhein
- Department of Radiology, Division of Neuroradiology, Spine Intervention Service, Duke University Medical Center, Durham, NC
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter G Kranz
- Department of Radiology, Division of Neuroradiology, Duke University Medical Center, Durham, NC
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12
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Chen CM, Lee JH, Yang MY, Jhang SW, Chang KS, Ou SW, Sun LW, Chen KT. Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study. Neurospine 2023; 20:141-149. [PMID: 37016862 PMCID: PMC10080431 DOI: 10.14245/ns.2346058.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients’ refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain.Methods: The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment.Results: The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study.Conclusion: Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.
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Affiliation(s)
- Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Jae Hwan Lee
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung Taiwan
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kai-Sheng Chang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Su-Wei Ou
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Puzi, Taiwan
- Corresponding Author Kuo-Tai Chen Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, No. 6, W. sec., Jiapu Rd., Puzi City, Chiayi County 613, Taiwan
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13
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Maccagnano G, Noia G, Cassano GD, Coviello M, Meluzio MC, Vicenti G, Tamburrelli FC, Perna A, Pesce V. Thermal versus cooled radiofrequency in patients with sacroiliac joint pain: a systematic review of the literature and pooled analysis of clinical outcomes. J Neurosurg Sci 2022; 66:485-493. [PMID: 35301836 DOI: 10.23736/s0390-5616.22.05525-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Chronic low back pain (LBP) can be caused by sacroiliac joint (SIJ) disease. Many conditions could cause SIJ dysfunction. The lateral branches of the L4-S3 dorsal rami are responsible for the primary innervation of the posterior SI joint. Radiofrequency (RF) denervation represent an emerging promising treatment for refractory sacroiliac joint pain. There are different types of RF denervation such as thermal or cooled. Use of irrigation cooled electrodes allows targeted tissues to reach the neuroablative temperatures slowly, preventing collateral damage of adjacent tissue. EVIDENCE ACQUISITION We conducted electronic database (PubMed, Medline, Cochrane and Google Scholar) research (time frame: January 1st, 2010 to May 31st, 2021) for clinical studies that had tested conventional radiofrequency (RFT) and cooled radiofrequency (RFC) to treat sacroiliac joint pain. These studies were evaluated according to Level of Evidence. Quantitative assessment of qualifying studies was done using the random effects model. We calculated the pooled size effect using standardized mean difference (SMD) as the main effect measure. EVIDENCE SYNTHESIS We identified nine studies, with a total of 276 patients affected by sacroiliac joint pain and treated with radiofrequency. The analysis revealed a small and non-significant difference in pain reduction and an improvement in quality of life in RFT subgroup (Pain measured in Visual Analogic Scale: RFT subgroups SMD=-3.643 (95% CI -4.478, -2.807), RFC subgroup SMD=-3.285 (95% CI -4.428, -2.141), P=0.587; Quality of Life measured in Oswestry Disability Index: RFT subgroup SMD=-35.969 (95% CI -53.993%, -17.945%), RFC subgroup SMD=-20.589% (95% CI -33.424%. -7.754%), P=0.123). Publication bias was found in quality-of-life assessment due to the low number and high heterogeneity of studies. Two techniques showed no major complications. CONCLUSIONS Current evidence indicates no statistical difference between two techniques examined. The literature is currently lacking, and well-constructed randomized clinical trials are necessary to evaluate this deficient aspect.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopedic Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Riuniti di Foggia Polyclinic Hospital, Foggia, Italy
| | - Giovanni Noia
- Orthopedic Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Riuniti di Foggia Polyclinic Hospital, Foggia, Italy -
| | - Giuseppe D Cassano
- Orthopedic Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, Bari Polyclinic Hospital, Bari, Italy
| | - Michele Coviello
- Orthopedic Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, Bari Polyclinic Hospital, Bari, Italy
| | - Maria C Meluzio
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giovanni Vicenti
- Orthopedic Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, Bari Polyclinic Hospital, Bari, Italy
| | | | - Andrea Perna
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Vito Pesce
- Orthopedic Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Riuniti di Foggia Polyclinic Hospital, Foggia, Italy
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14
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Du R, Xu G, Bai X, Li Z. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. J Pain Res 2022; 15:3689-3710. [PMID: 36474960 PMCID: PMC9719706 DOI: 10.2147/jpr.s389602] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/16/2023] Open
Abstract
Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.
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Affiliation(s)
- Ruihuan Du
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Gang Xu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
| | - Xujue Bai
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian, People’s Republic of China
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15
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Lowe M, Okunlola O, Raza S, Osasan SA, Sethia S, Batool T, Bambhroliya Z, Sandrugu J, Hamid P. Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials. Cureus 2022; 14:e26327. [PMID: 35911275 PMCID: PMC9311336 DOI: 10.7759/cureus.26327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/25/2022] [Indexed: 12/03/2022] Open
Abstract
Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as “High Risk” using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.
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16
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:34098. [PMID: 35769646 PMCID: PMC9235436 DOI: 10.52965/001c.34098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/06/2021] [Indexed: 04/05/2024] Open
Abstract
Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
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Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | - Christopher A Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
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17
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Urits I, Viswanath O, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:31915. [PMID: 36415486 PMCID: PMC9674090 DOI: 10.52965/001c.31915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2024] Open
Abstract
Sacroiliac joint (SIJ) pain is responsible for approximately a third of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
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Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | - Christopher A Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Shreveport
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Shreveport
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
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18
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Bogduk N. Physical examination tests technical accuracy of sacral lateral branch RFN. INTERVENTIONAL PAIN MEDICINE 2022; 1:100079. [PMID: 39238812 PMCID: PMC11372880 DOI: 10.1016/j.inpm.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
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Farì G, de Sire A, Fallea C, Albano M, Grossi G, Bettoni E, Di Paolo S, Agostini F, Bernetti A, Puntillo F, Mariconda C. Efficacy of Radiofrequency as Therapy and Diagnostic Support in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12030600. [PMID: 35328153 PMCID: PMC8947614 DOI: 10.3390/diagnostics12030600] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022] Open
Abstract
Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate the efficacy of RF in treating musculoskeletal pain. PubMed, Medline, Cochrane, and PEDro databases were searched to identify randomized controlled trials (RCTs) presenting the following: patients with chronic musculoskeletal pain as participants; RF as intervention; placebo, anesthetic injection, corticosteroid injection, prolotherapy, conservative treatment, physiotherapy, and transcutaneous electrical nerve stimulation as comparisons; and pain and functioning as outcomes. Continuous random-effect models with standardized mean difference (SMD) were used to compare the clinical outcomes. Overall, 26 RCTs were eligible and included in the systematic review. All of them analyzed the efficacy of RF in four different regions: cervical and lumbar spine, knee, sacroiliac (SI) joint, shoulder. The outcomes measures were pain, disability, and quality of life. A medium and large effect in favor of the RF treatment group (SMD < 0) was found for the shoulder according to the Visual Analogical Scale and for the SI joint according to the Oswestry Disability Index. A small effect in favor of the RF treatment group (SMD > 0) was found for the spine according to the 36-item Short Form Survey. Non-significant SMD was found for the other outcomes. RF represents a promising therapy for the treatment of chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Further studies are warranted to better deepen the effectiveness of RF for pain and joint function for each anatomical region of common application.
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Affiliation(s)
- Giacomo Farì
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, 70121 Bari, Italy
- Correspondence: (G.F.); (A.d.S.); Tel.: +39-0805593499 (G.F.); +39-0961712819 (A.d.S.)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (G.F.); (A.d.S.); Tel.: +39-0805593499 (G.F.); +39-0961712819 (A.d.S.)
| | - Cettina Fallea
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy; (C.F.); (M.A.); (G.G.); (E.B.); (C.M.)
| | - Mariantonia Albano
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy; (C.F.); (M.A.); (G.G.); (E.B.); (C.M.)
| | - Gianluca Grossi
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy; (C.F.); (M.A.); (G.G.); (E.B.); (C.M.)
| | - Elisa Bettoni
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy; (C.F.); (M.A.); (G.G.); (E.B.); (C.M.)
| | - Stefano Di Paolo
- Department of Biomedical and Neuromotor Science, IRCCS Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (A.B.)
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (A.B.)
| | - Filomena Puntillo
- Department of Interdisciplinari Medicine, Aldo Moro University, 70124 Bari, Italy;
| | - Carlo Mariconda
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy; (C.F.); (M.A.); (G.G.); (E.B.); (C.M.)
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Dey S, Das G, Surange P, Agarwal A, Kothari K, Natarajan K, Mehta P, Sharma G, Siddhaye U, Jain N, Mohan VK. Radiofrequency ablation in chronic pain syndromes: An evidence- and consensus-based indian society for the study of pain guidelines, 2022. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_123_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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21
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Candan B, Gungor S. Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain: A retrospective study. Medicine (Baltimore) 2021; 100:e28459. [PMID: 34967387 PMCID: PMC8718233 DOI: 10.1097/md.0000000000028459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/08/2021] [Indexed: 01/05/2023] Open
Abstract
Cooled-radiofrequency (CRFA) is a newer technique and may have some theoretical advantages over traditional radiofrequency ablation (TRFA). In this study, we aimed to investigate the efficacy and safety of CRFA for the treatment of lumbar facet joint-mediated pain. In this retrospective study, we evaluated 185 CRFA performed on 105 patients. All patients with axial lower back who received the preliminary diagnosis of lumbar facet joint-mediated pain and refractory to conservative therapy underwent diagnostic medial branch blocks. CRFA was recommended to those patients who responded favorably to two sets of diagnostic medial branch blocks. Pain scores in numeric rating scale (NRS) were recorded pre-treatment and post-treatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.Primary outcome measure determined as the improvement in NRS, for at least 50% or more, was achieved in both 1st (4-8 weeks) and 2nd (>2-6 months) follow-up (FU) with 60.5% and 53.6% reduction in NRS respectively. Our subgroup analysis comparing the younger (<50) and older (≥50) age groups showed superior pain relief with CRFA in the older (≥50) age group, both in the 1st (4-8 weeks) and 2nd (>2-6 months) FU time points (63.4% and 58.4% reduction in NRS, respectively). Cooled-radiofrequency ablation is an effective and safe procedure for the treatment of chronic lumbar facet joint related pain. The duration of pain relief was comparable to traditional radiofrequency ablation as reported in the literature.
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Affiliation(s)
- Burcu Candan
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Semih Gungor
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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22
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Yuan HJ, Wang CY, Wang YF. Endoscopic joint capsule and articular process excision to treat lumbar facet joint syndrome: A case report. World J Clin Cases 2021; 9:8545-8551. [PMID: 34754866 PMCID: PMC8554426 DOI: 10.12998/wjcc.v9.i28.8545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/27/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lumbar facet joint syndrome (LFJS) is a pain condition arising from lumbar facet joint diseases. Treatments of LFJS includes patient education, oral medication, bed rest, physical therapy, and procedural interventions. For some refractory cases that fail conservative therapies, dorsal ramus medial brunch radiofrequency ablation is warranted. However, as nerve fibers can regenerate, their efficacy is impermanent, and the recurrence rate is relatively high. Considering synovial impingement is a paramount pathogenesis of LFJS, in this case, we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope. As the culprit hyperplastic joint capsule was excised, it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment. CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS. She complained of low back pain and right buttock pain for half a year. The patient was placed in the prone position. After disinfection and draping, a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process. Subsequently, a guidewire, dilating tubes, and a working cannula was inserted successively. The spinal endoscope was positioned in the working cannula. Under the endoscope, the microvascular tissue, muscle tissue attached on the L5 inferior articular process and S1 superior articular process, as well as the capsule and minor portion of the inferior articular process were removed. After the joint space was clear and no bleeding points existed, the endoscope and working cannula were shifted, and the incision was sutured. After treatment, the symptoms were completely relieved. The patient was pain-free during the follow-up period of 6 mo. CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS, especially for cases caused by synovial impingement.
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Affiliation(s)
- Hong-Jie Yuan
- Department of Pain Medicine, Nantong Hospital of Traditional Chinese Medicine, Nantong 226001, Jiangsu Province, China
| | - Chun-Yan Wang
- Department of Cardiovascular, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Yu-Feng Wang
- Department of Radiology, Jinshan Branch, Shanghai Sixth People’s Hospital, Shanghai 201599, China
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Abstract
Radiofrequency ablation (RFA) is a potential treatment for those with sacroiliac joint (SIJ) pain. There is no consensus on the optimal procedural techniques for SIJ diagnostic blocks, or RFA. This article describes different techniques for SIJ diagnostic blocks and RFA, including the relevant innervation that underlies these techniques. SIJ RFA techniques differ in important ways, including lesioning techniques, needle placements, and type of RFA cannula used. Clinicians utilize a variety of image guidance modalities for SIJ RFA; fluoroscopic guidance is standard, although endoscopic and ultrasound-guided techniques are described. Additional studies are necessary to delineate potential differences between SIJ RFA techniques.
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A New Strategy for Rapid Diagnosis of the Source of Low Back Pain in Patients Scheduled to Undergo Treatment with Cooled Radiofrequency Ablation. Diagnostics (Basel) 2021; 11:diagnostics11101822. [PMID: 34679520 PMCID: PMC8534588 DOI: 10.3390/diagnostics11101822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/07/2023] Open
Abstract
Objective: The objective of this study was to develop a new strategy for rapid diagnosis of the source of low back pain (LBP) for treatment with cooled radiofrequency ablation (RFA). Materials: Patients suffering from facet joint (FJ) or sacroiliac joint (SIJ) pain for more than 3 months were included. Two methods, Technetium Tc99m methylene diphosphonate single photon emission tomography/computed tomography (99mTc-MDP SPECT/CT) and a modified Fortin finger test were used to identify the source of LBP for treatment with cooled RFA. The visual analog scale (VAS) and Oswestry disability index (ODI) were used to assess the patients’ pain levels and disabilities respectively. These two measures were recorded at baseline and 1-week, 1-month, 3-month, and 6-month follow-up visits. Results: A total of 40 patients with LBP were included in this study. Our results demonstrated that the patients with LBP identified by our new strategy had significant improvements in VAS or ODI score at 1-week to 6-month follow-up visits (p < 0.001) after receiving cooled RFA. Similar results were also found in patients with FJ pain and those with FJ and SIJ pain respectively. Among all the patients, over 70% had greater than or equal to 50% reduction in VAS and ODI scores. No serious adverse events were observed after treatment. Conclusions: This new strategy could be successfully adopted for rapid diagnosis of the source of comprehensive LBP.
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Lee DW, Pritzlaff S, Jung MJ, Ghosh P, Hagedorn JM, Tate J, Scarfo K, Strand N, Chakravarthy K, Sayed D, Deer TR, Amirdelfan K. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2021; 14:2807-2831. [PMID: 34526815 PMCID: PMC8436449 DOI: 10.2147/jpr.s325665] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/21/2021] [Indexed: 01/02/2023] Open
Abstract
Radiofrequency neurotomy (RFN), also known as radiofrequency ablation (RFA), is a common interventional procedure used to treat pain from an innervated structure. RFN has historically been used to treat chronic facet-joint mediated pain. The use of RFN has more recently expanded beyond facet-joint mediated pain to peripherally innervated targets. In addition, there has also been the emergence of different radiofrequency modalities, including pulsed and cooled RFN. The use of RFN has been particularly important where conservative and/or surgical measures have failed to provide pain relief. With the emergence of this therapeutic option and its novel applications, the American Society of Pain and Neuroscience (ASPN) identified the need for formal evidence-based guidance. The authors formed a multidisciplinary work group tasked to examine the latest evidence-based medicine for the various applications of RFN, including cervical, thoracic, lumbar spine; posterior sacroiliac joint pain; hip and knee joints; and occipital neuralgia. Best practice guidelines, evidence and consensus grading were provided for each anatomical target.
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Affiliation(s)
- David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, 92831, USA
| | - Scott Pritzlaff
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | - Michael J Jung
- University of California, Davis.,Division of Pain Medicine, Sacramento, CA, USA
| | | | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jordan Tate
- Alliance Spine and Pain Centers, Canton, GA, USA
| | - Keith Scarfo
- Warren Alpert Medical School of Brown University Department of Neurosurgery - Norman Prince Spine Institute, Rhode Island Hospital, Providence, RI, USA
| | - Natalie Strand
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Inc., Charleston, WV, USA
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Sahoo RK, Das G, Pathak L, Dutta D, Roy C, Bhatia A. Cryoneurolysis of Innervation to Sacroiliac Joints: Technical Description and Initial Results-A Case Series. A A Pract 2021; 15:e01427. [PMID: 33783380 DOI: 10.1213/xaa.0000000000001427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The sacroiliac joint (SIJ) is a common source of pain in patients with low back pain. Untreated pain from the SIJ can lead to prolonged discomfort and financial burden. Interventional treatments for SIJ-related pain include intraarticular steroid injection and radiofrequency ablation but both procedures provide pain relief for a limited duration. Cryoneurolysis is another neuroablative technique that is effective in various chronic pain conditions. However, there is no clear description of SIJ cryoneurolysis in the published literature. In this report, we present 5 patients with SIJ-related pain and we describe the ultrasound-guided SIJ cryoneurolysis technique and its analgesic efficacy.
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Affiliation(s)
- Rajendra Kumar Sahoo
- From the Department of Anesthesiology and Pain management, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Gautam Das
- Department of Pain Medicine, Daradia Pain Hospital, Kolkata, India
| | - Laxmi Pathak
- Department of Pain Medicine, Daradia Pain Hospital, Kolkata, India
| | - Debjyoti Dutta
- Department of Pain Medicine, Daradia Pain Hospital, Kolkata, India
| | - Chinmoy Roy
- Department of Pain Medicine, Daradia Pain Hospital, Kolkata, India
| | - Anuj Bhatia
- Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, University of Toronto, Toronto, Ontario
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Sansone P, Giaccari LG, Lippiello A, Aurilio C, Paladini A, Passavanti MB, Pota V, Pace MC. Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Viable Therapeutic Option? A Retrospective Observational Study. Pain Ther 2020; 9:573-582. [PMID: 32770486 PMCID: PMC7648804 DOI: 10.1007/s40122-020-00187-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Low back pain (LBP) is a common problem, and facet joint pain is responsible for 15–45% of cases. Treatment is multidisciplinary, and when conservative measures are not sufficient, radiofrequency (RF) is often used. It allows the interruption of nociceptive input, producing a heat lesion in a continuous or pulsed mode. Methods Medical records of 60 patients who underwent pulsed RF denervation were examined. The standard procedure provided follow-up of pain intensity. Numerical rating scale (NRS) and Douleur Neuropathique en 4 Questions (DN4) were recorded before treatment, and 15 and 40 days, and 6 months after treatment. Oswestry Disability Index (ODI) and patient satisfaction were also recorded. Successful treatment was defined as more than a 50% reduction in the NRS scores at 6 months compared with pretreatment scores. Results Scores on the NRS and DN4 were statistically different over time (p < 0.05). Scores at 6 months were significantly decreased when compared with pretreatment scores (p < 0.05). ODI scores decreased during the follow-up period. No adverse effect was recorded and 57 patients (97%) reported successful pain relief. Conclusions Continuous RF is the gold standard in the management of lumbar facet joint pain. Pulsed RF is a promising technique: patients with chronic LBP who had not responded to conservative care tended to improve after pulsed RF. The procedure was well tolerated in the absence of contraindications, and reliable if the nerve endings regrew.
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Affiliation(s)
- Pasquale Sansone
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Luca G Giaccari
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Lippiello
- Department of Neurosurgery, "Santa Maria delle Grazie Hospital", Pozzuoli, Italy
| | - Caterina Aurilio
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Maria Beatrice Passavanti
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Pota
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Children and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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