Abstract
BackgroundImaging results are frequently considered as hallmarks of disease by spine surgeons to plan their future treatment strategy. Numerous classification systems have been proposed to quantify or grade lumbar magnetic resonance imaging (MRI) scans and thus objectify imaging findings. The clinical impact of the measured parameters remains, however, unclear. To evaluate the pathological significance of imaging findings in patients with multisegmental degenerative findings, clinicians can perform image-guided local infiltrations to target defined areas such as the facet joints.The aim of the present retrospective study was to evaluate the correlation of MRI facet joint degeneration and spinal stenosis measurements with improvement obtained by image-guided intraarticular facet joint infiltration.MethodsFifty MRI scans of patients with chronic lumbar back pain were graded radiologically using a wide range of classification and measurement systems. The reported effect of facet joint injections at the site was recorded, and a comparative analysis performed.ResultsWhen we allocated patients according to their reported pain relief, 27 showed no improvement (0–30%), 16 reported good improvement (31–75%) and 7 reported excellent improvement (> 75%). MRI features assessed in this study did, however, not show any relevant correlation with reported pain after facet joint infiltration: Values for Kendall’s tau ranged from τ = − 0.190 for neuroforaminal stenosis grading as suggested by Lee, to τ = 0.133 for posterior disc height as proposed by Hasegawa.ConclusionDespite the trend in evidence-based medicine to provide medical algorithms, our findings underline the continuing need for individualised spine care that, along with imaging techniques or targeted infiltrations, includes diagnostic dimensions such as good patient history and clinical examination to formulate a diagnosis.Trial registrationClinicalTrials.gov, NCT03308149, retrospectively registered October 2017
Highlights
Imaging results are frequently considered as hallmarks of disease by spine surgeons to plan their future treatment strategy
No consensus has been established about whether radiologic imaging can predict the response to diagnostic or therapeutic facet joint blocks (reviewed by Cohen and Raja (2007)) [17]. In their 2010 study, Stojanonic et al described a possible association between magnetic resonance imaging (MRI) spinal stenosis and successful extra-articular medial branch block infiltrations
The preinfiltration pain level on a numeric rating scale was 4 (3–9), with a median improvement after facet joint infiltration of 30% (0–100%) (Fig. 2b)
Summary
Imaging results are frequently considered as hallmarks of disease by spine surgeons to plan their future treatment strategy. Numerous classification systems have been proposed to quantify or grade lumbar magnetic resonance imaging (MRI) scans and objectify imaging findings. The aim of the present retrospective study was to evaluate the correlation of MRI facet joint degeneration and spinal stenosis measurements with improvement obtained by image-guided intraarticular facet joint infiltration. No consensus has been established about whether radiologic imaging can predict the response to diagnostic or therapeutic facet joint blocks (reviewed by Cohen and Raja (2007)) [17]. In their 2010 study, Stojanonic et al described a possible association between MRI spinal stenosis and successful extra-articular medial branch block infiltrations. Even though these study results failed to reach statistical significance, this finding might offer an additional perspective on how to consider the effects observed by facet joint infiltrations [18]
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