Abstract
The aim of this retrospective practice audit was to assess the correlation between painful zygapophysial joints and changes seen in magnetic resonance imaging (MRI). Patients with unilateral pain were tested with controlled medial branch blocks. The MRI scans of patients with a positive response were compared blinded with normal MRI scans. The dimensions of the joint were assessed and osteoarthritis was graded. Fifteen symptomatic patients and 15 asymptomatic patients were included and evaluated. Comparison of the joints showed that the maximum diameter of symptomatic joints was significantly larger, and the grading of osteoarthritis was significantly higher for symptomatic joints. No healthy patient was assigned a grade 3. Grades 2 and 3 were found significantly more often in symptomatic patients. Only one symptomatic joint was assigned grade 0. Grade 0 was found significantly more often in asympto-matic patients. The presented MRI technique has limited value as a diagnostic test for lumbar zygapophysial joint pain. It is not possible to detect a single symptomatic joint. However, the osteoarthritis grading for the lumbar zyg-apophysial joints might be helpful for finding predictors for negative response if the results of the rating are grade zero. Therefore, unnecessary medial branch blocks might be avoided.
Highlights
For a specific treatment of patients with low back pain the identification of the pain source is important
The osteoarthritis grading for the lumbar zygapophysial joints might be helpful for finding predictors for negative response if the results of the rating are grade zero
In most of them (66.7%) controlled medial branch blocks were performed; the other five patients did not agree to a second medial branch block because of the pain reduction after the first treatment
Summary
For a specific treatment of patients with low back pain the identification of the pain source is important. The zygapophysial joints are a possible pain source for which radiofrequency denervation exists as a specific treatment. Freund 2 sis of lumbar zygapophysial joint pain provides the cardinal indication for treatment with medial branch neurotomy [1]. The most accepted method [1] for diagnosing zygapophysial joint pain is controlled medial branch blocks. They are used to test if the pain stems from the zygapophysial joint because the medial branch innervates it [1]
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