Diagnosing Lumbar Zygapophysial Joint Pain

Abstract

In their review of the literature on lumbar radiofrequency neurotomy and zygapophysial joint blocks, Hooten, Martin, and Huntoon [1] make several salient points. They indicate that systematic reviews of lumbar radiofrequency neurotomy have focused on conventional aspects of methodology, such as randomization, sample size, and outcomes, but that these reviews did not address two seminal, clinical matters: diagnosis and operative technique. On operative technique, Hooten, Martin, and Huntoon [1] correctly point out that for lumbar radiofrequency neurotomy to be credible and effective, electrodes need to be placed parallel to the target nerve. This very point is elaborated in another recent study [2]. None of the controlled studies covered by the systematic reviews used such a technique. Therefore, none of the studies and none of the reviews constitutes an evaluation of the procedure is it should be correctly performed. As Hooten, Martin, and Huntoon [1] state, only Dreyfuss et al. [3] used the correct technique, and their study provides the benchmark for expectable outcomes. On the matter of diagnosis, Hooten, Martin, and Huntoon [1] reveal that none of the controlled trials properly established a diagnosis of lumbar zygapophysial joint pain before venturing to test a treatment for that condition. The criterion standard for the diagnosis are controlled, diagnostic blocks, but no study used controlled blocks. Therefore, the samples recruited are very likely to have included false-positive cases, which would have confounded the outcomes of the studies, by reducing the apparent success rates. For this reason, none of the controlled studies and none of the systematic reviews constitutes proper evidence of the efficacy of lumbar radiofrequency neurotomy. Again, only Dreyfuss et al. [3] used controlled blocks to select their patients. Hooten, Martin, and Huntoon [1] proceed …