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.
Highlights
We attempted to modify the Fortin finger test and our results showed that the modified Fortin finger test could identify sacroiliac joint (SIJ) pain but facet joint (FJ) pain as well, the results demonstrated that a relatively low percentage (21–25%) of sources was simultaneously identified by both 99m Tc-MDP SPECT and the modified Fortin finger test for FJ or SIJ pain
This study developed a new strategy for rapid diagnosis of the source of comprehensive low back pain (LBP) undergoing treatment with cooled radiofrequency ablation (RFA)
Fortin finger test were combined for identifying the source of LBP
Summary
Low back pain (LBP) is one of the most common diseases affecting about 12% of Taiwanese adults [1] and is the leading cause of disability worldwide [2]. LBP incurs a substantial economic burden which is estimated to exceed $100 billion dollars annually for the treatment of this disease in the United States [3]. The potential sources of LBP of the spinal column are soft tissue, disc degeneration, and joints related to nociplastic pain. The major sources of LBP are lumbar facet joints (FJ) (21–41% of patients) [4]. Sacroiliac joints (SIJ) (16–30% of patients) [5]. Achieving a definitive diagnosis for patients with LBP is difficult, and the treatment is not always effective [6].
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