Facet Joint Degeneration Research Articles

Mechanical Needling with Sterile Water versus Steroids Injection for Facet Joint Syndrome: A Retrospective Observational Study

Objective. This present study aimed to explore the clinical effects of ultrasound-guided (USG) mechanical needling with sterile water injection for lumbar facet joint syndrome. Methods. This was a retrospective cohort study that assessed the clinical outcome of ageing patients who received USG mechanical needling with sterile water injection. In addition, the clinical outcome of age- and gender-matched patients randomly selected from patients who received mechanical needling with sterile water was compared to the patients injected with steroids in a 2 : 1 ratio. The data were extracted from the medical records of ageing patients with facet joint syndrome who received USG injection at the lumbosacral spine by the first author. Low back pain or axial pain, and leg pain or radicular pain were assessed by the visual analogue scale (VAS), and gait ability with walking distance was obtained at 6 different time points. Results. A total of 4,276 medical records were examined. Four thousand two hundred twenty-eight ageing patients received needling with sterile water injection and found that the efficacy lasted up to 6 months. Ninety-six patients were compared with 48 patients who received steroid injection. Those who received steroids had less back and leg pain at 1 week after injection; however, pain returned at 3 months and 6 months after injection. Conclusions. USG mechanical needling with sterile water could help relieve axial and radicular pain for at least 6 months. Reduced sensitization and removal of calcification and fibrosis were all possible mechanisms.Keywords: Mechanical needling, Sterile water, Ultrasound guided (USG) injection, Facet joint syndrome, Pain

Predictors for second-stage posterior direct decompression after lateral lumbar interbody fusion: a review of five hundred fifty-seven patients in the past five years

PurposeTo analyze the predictors for second-stage posterior direct decompression (PDD) after lateral lumbar interbody fusion (LLIF) procedure.MethodsWe studied patients who underwent LLIF for degenerative lumbar spinal stenosis in the last five years, from July 2016 to June 2021. All surgical levels were grouped according to Schizas’ central canal stenosis (CCS) classification, Pathria’s facet joint degeneration (FJD) classification, Bartynski’s lateral recess stenosis (LRS) classification, and Lee’s foraminal stenosis (FS) classification. Second-stage PDD rates of each subgroup and their annual change were analyzed. Evaluation of risk factors associated with PDD was investigated.ResultsA total of 901 segments from 557 patients were included. The overall PDD rate was 29.97%. An overall PDD rate of 75.21% for grade D CCS, 29.74% for grade C CCS, 41.67% for grade 3 FJD, 37.61% for grade 3 LRS, and 40.70% for grade 3 FS was shown. While there was a continuous decline in annual PDD rate in the past four years, the annual PDD rate for grade D remained at very high levels. Logistic regression analysis had shown grade D CCS as the utmost risk factor for PDD (OR = 17.77). And grade 3 LRS (OR = 4.63), grade 3 FS (OR = 2.42), grade C CCS (OR = 2.41), and grade 3 FJD (OR = 2.04) were also moderately correlated with PDD, which meant they only moderately increased the risk of PDD.ConclusionExtreme severe lumbar CCS (grade D) is the greatest determinant to perform the second-stage PDD procedure after LLIF.

Syndrome of the intervertebral and sacroiliac joints ("facet syndrome") in the pathology of the lumbosacral spine

The purpose of the work was to detection of facet syndrome of lower lumbar intervertebral and sacro-iliac joints in various types of spine pathology. In 1044 patients with facet syndrome the examination and treatment results were analysed. Manual therapy was shown to be one of the main methods for the treatment of facet syndrome with functional block. The application of that method enabled to achieve good and satisfactory results in 97,5% of cases.

Mulligan mobilization versus traction in lumbar facet joint syndrome: randomized controlled trial

The aim of this study was to investigate and compare the effect of Mulligan mobilization, lumbar traction and their combination on pain, functional disability and facet tropism in patients with facet joint syndrome. Sixty patients with facet joint syndrome from both sexes and aged 30 to 50 years participated in the randomized controlled trial design. They were referred from orthopedic and neurological clinics and divided into four groups as follows: group A received Mulligan mobilization and conventional treatment, group B received lumbar traction and conventional treatment, group C received Mulligan mobilization in combination with lumbar traction in addition to conventional treatment, while group D (control group) received the conventional treatment only. All participants received 3 treatment sessions per week for one month. The assessments were done before and after one month of treatment using Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, and magnetic resonance image (MRI) for facet joint tropism. Statistically significant improvement was found in pain and functional disability in all four groups post-treatment (p<0.05), compared to pre-treatment, with the study groups (A, B and C) having a higher improvement than the control group (D). The improvement in group C was significantly higher than in groups A and B (p<0.05), and the improvement in group A was significantly higher than in group B (p<0.05). Regarding the facet joint tropism, there was a statistically significant improvement in the four groups post-treatment (p<0.05) compared with pre-treatment, with higher significant improvements in the study groups (A, B, C) in comparison with the control group (D). There was no statistically significant difference in tropism between groups A, B and C. The combination of Mulligan mobilization and lumbar traction (group C) was the most effective treatment for relieving pain and functional disability in patients with facet joint syndrome. Regarding facet tropism, there was a statistically significant improvement with all the treatments, but the conventional treatment produced the lowest improvement.

Relationship Among the Foraminal Area and Demographic and Clinical Characteristics of Patients with Low Back Pain

Our study aims to contribute to existing knowledge by evaluating patients with low back pain to provide a more accurate relationship between the diameter of the intervertebral foramen and the clinical, demographic, and lumbar spine anatomic factors such as age, sex, body mass index, the Zurich Claudication Questionnaire, facet joint, intervertebral disc, ligamentum flavum, and spinal canal. We studied 90 consecutive patients who had undergone evaluation for low back pain. We used magnetic resonance imaging to assess the cross-sectional areas of the intervertebral foramina at each level of the lumbar spine together with the ligamentum flavum area and the dural sac cross-sectional area (DSCSA) measurements. The presence of disc and facet joint degeneration was evaluated and data on symptoms were obtained. Age (P < 0.0001), lumbar disc degeneration grade (P= 0.016), and DSCSA (P < 0.0001) were found to statistically significantly influence the foraminal area (FA). The mean FA at all lumbar levels increased with increasing DSCSA. The mean FA decreased with age at all levels except L5/S1. Lumbar disc degeneration grade 1-3 increased the mean FA at L5/S1, but not at other levels. No statistically significant effects of the side of the measurement, sex, body mass index, Zurich Claudication Questionnaire score, ligamentum flavum area, or facet joint degeneration were found. The results of the present study allow us to quantify the effect of age, DSCSA, and lumbar disc degeneration grade on the FA.

Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration.

The relationship between degenerative changes of the sacroiliac joints and the lumbar spine on CT has not been studied yet. The aim of this analysis is to determine the nature of their association as well as the influence of fixed anatomical spinopelvic parameters on sacroiliac joint degeneration. For this institutional review-board-approved investigation, imaging datasets as well as electronic medical records of 719 patients without back pain from the clinical routine of our department of radiology were included. Age, sex, weight category (slim, normal, obese), parity in women and indication for imaging were noted for all patients. The presence of degenerative lesions of the lumbar spine (disc degeneration, endplate degeneration, spondylophytes, and facet joint osteoarthritis) was noted separately at each lumbar segment (L1 to L5). Sacroiliac joints were assessed for sclerosis and osteophytes. Fixed anatomical spinopelvic parameters were measured: pelvic radius = PR; pelvic incidence = PI; sacral table angle = STA. Correlation as well as regression analyses were performed; data were analyzed for males and females separately. PI increased significantly with age in both women and men, while STA decreased and PR remained constant; neither of them was associated with SIJ degeneration. SIJ degeneration correlated with disc degeneration (tau = 0.331; p < 0.001), spondylophytes (tau = 0.397; p < 0.001), and facet joint degeneration (tau = 0.310; p < 0.001) in men, but with no parameter of spinal degeneration in women. Lumbar spinal degeneration increased the risk of sacroiliac joint degeneration in men significantly (OR 7.2; 95%CI 2.8–19.0), but it was not a significant covariable in women. Fixed spinopelvic parameters have little impact on sacroiliac joint degeneration. The degeneration of the sacroiliac joints and the lumbar spine appear to be parallel processes in men, but are largely unrelated in women.

Результати лікування хворих із нижньопоперековим больовим синдромом, де домінували прояви спондилоартрозу, із використанням радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків та стероїдних препараті

Актуальність. Висока поширеність дегенеративно-дистрофічного ураження хребта при малій ефективності терапії спондилоартрозу робить актуальним дослідження щодо лікування нижньопоперекового болю, зумовленого переважно спондилоартрозом, інноваційним міні-інвазивним методом високочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів. Мета дослідження: визначити ефективність впливу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів з урахуванням ранніх та віддалених результатів лікування на ліквідацію больового синдрому у хворих із нижньопоперековим больовим синдромом, в яких переважали прояви спондилоартрозу. Матеріали та методи. Проведений аналіз ранніх та віддалених результатів лікування 78 пацієнтів (37 чоловіків та 41 жінка віком від 51 до 79 років) із нижньопоперековим больовим синдромом, в яких провідним клінічним проявом був артроз дуговідросткових суглобів, які становили основну групу, та проведена радіочастотна денервація фасеточних суглобів (за допомогою апарата RFG-1A/RFG-1B фірми Radionics) у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату. Оцінка больового синдрому проводилася чотири рази — у доопераційному, післяопераційному періодах (протягом тижня), через три місяці та через один рік після лікування. Використовувалася візуальна аналогова шкала болю та опитувальник індексу непрацездатності Освестрі. Контрольну групу становили 136 пацієнтів (73 чоловіки та 63 жінки віком від 44 до 81 року) із нижньопоперековим болем із домінуванням проявів спондилоартрозу, які лікувались виключно за допомогою методу радіочастотної денервації фасеточних суглобів. Результати. Як відразу ж після проведеного лікування, так і через три місяці після його здійснення отриманий вірогідний результат лікування хронічного нижньопоперекового больового синдрому, зумовленого переважно ураженням дуговідросткових суглобів, як в основній, так і контрольній групах, що свідчить про ефективність обох методів лікування. Разом із тим відмічається чітка вірогідна різниця між основною та контрольною групами як відразу після проведеного лікування, так і через три місяці після його здійснення, що свідчить про вірогідну вищу ефективність методу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату в ранньому післяопераційному періоді. У віддаленому періоді (через 1 рік після лікування) отриманий вірогідний результат лікування як в основній так і в контрольній групах, але відмінність у результатах лікування між цими групами відсутня. Висновки. Отримані результати в ранньому та віддаленому періодах після лікування свідчать про ефективність та безпечність як радіочастотної денервації фасеточних суглобів, так і радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату у хворих із нижньопоперековим больовим синдромом, де домінують прояви спондилоартрозу. Вірогідно кращі результати в ранньому періоді отримані в групі пацієнтів, яким проводилось поєднання радіочастотної денервації фасеточних суглобів із періартикулярним введенням місцевого анестетика та стероїдного препарату. Тоді як у віддаленому періоді (через 1 рік після лікування) така відмінність між основною та контрольною групами відсутня. Періартикулярне введення місцевих анестетиків та стероїдів ефективне в короткотерміновій перспективі, а радіочастотна денервація фасеточних суглобів ефективна як у короткотерміновій, так і в довготерміновій перспективі. Обидві методики можуть бути рекомендовані до включення в алгоритм лікування фасеточного синдрому при неефективності консервативного лікування.

Hyperextension-distraction fractures in ankylosing and spondylotic spines: injury profile and treatment results.

Case series study. To describe demographic metrics, and clinical and radiographical outcomes of surgical treatment in patients with ankylosed spine (ASP) such as diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis (AS) and non-ankylosed spines (NAS) suffering from hyperextension-distraction spine fractures. Patients diagnosed with hyperextension-distraction fractures between 2012 and 2020 were identified. A retrospective analysis of clinical and surgical data was performed. Similarities between patients with ASP and NAS were evaluated by Fisher's exact test. Of the 22 patients, 13 had ASP (10 patients with DISH, 3 AS) and nine NAS. Most of these injuries involved the thoracolumbar spine (45.4%). All patients with NAS presented some sign of spondylosis: facet joint degeneration, intervertebral osteochondrosis, and anterolateral osteophytes. None of the patients with NAS and 30.7% with ASP suffered low-energy mechanisms (p = .11). All the patients with NAS and 61% of the patients with ASP had associated injuries (p = .04). On average, the instrumented levels were four(range, 2-6), achieving a fusion rate of 94.7% in all groups. Most of the ASP and NAS presented post-operative complications respectively (p = .65). Hyperextension-distraction spine fractures are not unique in ASP. In patients with spondylosis and high-energy accidents, we should suspect those fractures and rule out associated injuries, fractures in other vertebral segments, and acute spinal cord injury. The four-level instrumentation achieved an effective fusion rate in all patients.

Changes in Paraspinal Muscles and Facet Joints after Minimally Invasive Posterior Lumbar Interbody Fusion Using the Cortical Bone Trajectory Technique: A Prospective Study.

In this prospective cohort study, we aimed to determine the surgical and adjacent segment changes in paraspinal muscles and facet joints in patients with lumbar spinal stenosis after minimally invasive posterior lumbar interbody fusion (PLIF) using the cortical bone trajectory (CBT) technique. We enrolled 30 consecutive patients who underwent the single-level CBT technique between October 2017 and October 2018. We evaluated preoperative and 1-month, 3-month, 6-month, and 1-year postoperative clinical data including Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI). Magnetic resonance imaging (MRI) was performed a year after surgery. The erector spinae (ES) muscle area, volume, and fat infiltration (FI) on the surgical and adjacent segments were evaluated using the thresholding method, and the degree of adjacent facet joint degeneration was calculated using the Weishaupt scale. FI rate was graded using the Kjaer method. All patients underwent a 12-month follow-up. The VAS and ODI scores significantly improved after surgery in all patients. No patient showed degeneration of the adjacent facet joints (P > 0.05) during the 1-year follow-up postoperation. There was no significant difference in ES muscle volume, area, and FI on the surgical and adjacent segments (P > 0.05). The FI rate of the upper ES muscles increased postoperatively (P < 0.05); however, there were no significant changes in FI rate of the lower ES muscles. Patients with lumbar spinal stenosis could obtain satisfactory short-term clinical outcomes via minimally invasive PLIF using the CBT technique. Moreover, this technique may reduce the impact on the paravertebral muscles, especially the ES muscle, and the adjacent facet joints.

Research progress of diagnosing methodology for lumbar segmental instability: A narrative review.

Objective:Lumbar segmental instability (LSI) is due to a pathologic movement of the vertebral body on the vertebra below and often causes clinical symptoms. The study was to achieve the research progress of diagnosing methodology for lumbar segmental instability and help clinicians make treatment choices.Methods:The data for this study were collected from the MEDLINE, Springer, Web of Science, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. The search terms were integrated as follows: “(∗lumbar instability∗ OR ∗lumbar spondylolisthesis∗) and (∗image∗ or ∗diagnosis∗)”. Studies without clear radiographic instable criteria, case reports, letter, and basic research were excluded.Result:In total, 39 articles published met our inclusion criteria. The various modalities were used to diagnosis LSI in these studies included radiographs, facet joint degeneration and physical examination tests.Conclusion:Overall, there have been a variety of researches to develop the diagnosing methodology for LSI, and many have been successful, although no consensus has been reached yet. However, it is believed that the diagnosis of LSI will become easier and more accurate in the near future.

RADIOFREQUENCY DENERVATION OF THE FACET JOINTS AND LOCAL PERIARTICULAR ADMINISTRATION OF ANAESTHETICS IN FACET SYNDROME TREATMENT.

The aim: To determine the effectiveness of radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics in patients with facet syndrome. Materials and methods: The early and long-term results of treatment patients with facet syndrome were analysed. The Visual Analogue Scale of pain and the Oswestry Disability Index were used. The 47 patients underwent radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics (the main group). The 136 patients underwent only radiofrequency denervation of the facet joints (control group). Results: Immediately after the treatment as well as in 3 months and in 1 year after it, a reliable results of treatment of facet syndrome in both the main and the control groups was attained. At the same time, there were significant differences between the main group and the control group immediately after treatment. But in 3 months and in 1 year after it there were no such differences that proved a significantly higher efficiency of high radiofrequency denervation of facet joints in combination with periarticular administration of local anaesthetics in the early postoperative period. Conclusions: The radiofrequency denervation of the facet joints has proved to be an effective method of treatment of patients with spondyloarthritis both in the short and long term outcomes. Periarticular administration of local anaesthetics enhances the effectiveness of radiofrequency denervation of the facet joints only for the short term outcomes.

Characterization of Clinical Symptoms of Cervical Spondylotic Myelopathy Based on DKI Imaging Parameter Ratios.

In recent years, people's living conditions have significantly improved, and their lifestyles have been diversified. However, the incidence of various diseases has also increased with it, including cervical spondylotic myelopathy (CSM). Spinal cord cervical spondylosis is one of the spinal cord compression disorders that can be severely disabling and accounts for 10% to 15% of all cervical spondylosis. In this paper, DKI image processing technology is used to study the symptoms of cervical spondylosis, which is helpful to help them explore the symptoms and causes. The onset of cervical spondylosis has a longer period of time, and the period of conservative treatment will inevitably require a longer period of time. The clinical symptoms of cervical spinal cord compression are mainly pain, and after the cervical spinal cord nerve is compressed, ischemia and hypoxia will occur, the nerve sensitivity will increase, and the patient will have reflex neck muscle pain symptoms. This causes degeneration of the patient's intervertebral disc tissue, degeneration of facet joints, ossification of the posterior longitudinal ligament, and formation of spurs on the posterior edge of the vertebral body. The condition will become more complicated, so it is very important to identify the characteristics of the clinical symptoms of cervical spondylotic myelopathy to help patients with cervical spondylosis recover. This paper identifies the clinical symptoms of cervical spondylosis based on the parameter ratio method of Diffusional Kurtosis Imaging (DKI). The current state of diffusion kurtosis imaging and the treatment of cervical spondylosis and the treatment operation are introduced, and the image enhancement technology in medical imaging is used to analyze the disc herniation of each segment in the overflexion, neutral and hyperextension positions. After comparing the FA, MK, and MD values in the spinal cord between the normal group and the patient group, the results showed that the FA, MD and MK values in the patient group were lower than those in the normal group, and the findings showed that the MD and MK values were positively correlated with the JOA score, reflecting that as the clinical symptoms of spinal cervical spondylosis worsened. The size and number of cervical intervertebral disc bulge on the hyperextension image is obvious and the number increases (especially the C4/5, C5/6, and C6/7 intervertebral discs with greater mobility), and the highest is 0.82 and 27%, respectively.

Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs

To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD). A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD. Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m2) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease. Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.

Rehabilitation on Cervical Spondylosis

Cervical Spondylosis (SC) is the most common disorder of the cervical spine. Intervertebral discs can degenerate as a result of natural aging. Other degenerative changes include osteophyte formation, facet joint hypertrophy, longitudinal ligament calcification, and ligament flava thickening. Aim: The aim of this study is to show the different methods of physiotherap used for the rehabilitation of cervical spondylosis and to compare among them the combined methods to see which of the methods is most effective in terms of relieving the main symptoms of cervical spondylosis.

Фасеточный синдром поясничного отдела позвоночника

The article is devoted to modern methods of diagnosis and treatment of pain syndromes caused by the development of degenerative destructive changes in the intervertebral joints (facet syndrome). The modern therapeutic tactics of the disease are described; indications for the surgical treatment of the disease are presented. Modern methods of surgical treatment of facet syndrome are briefly and schematically described. The data of the immediate and long-term results of surgical methods of treatment of facet syndrome are presented. English version of the article is available at URL: https://panor.ru/articles/faceted-lumbar-spine-syndrome/78489.html

Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study.

BackgroundLow back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection.MethodsThis was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later.ResultsA total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13–18.ConclusionFor the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

Clinical and radiological mid- to long-term investigation of anterior lumbar stand-alone fusion: Incidence of reoperation and adjacent segment degeneration

IntroductionAnterior stand-alone fusion (ASAF) devices have been developed in an attempt to reduce adjacent segment degenerative changes observed with posterior instrumented fusion techniques. Research questionThe purpose of this study was to assess mid- to long-term clinical and radiological results following ASAF at the lumbosacral junction with special emphasis on the assessment of adjacent level pathologies.Materials & Methods: Clinical outcome scores and radiological data were acquired within an ongoing single-center prospective cohort study. Progression of adjacent level degeneration was evaluated based on MRI scans according to the Pfirrmann and Weishaupt classification system by two independent radiologists. ResultsThe results from 37 patients (FU ​≥ ​5 years) demonstrated high satisfaction rates and significant improvements in VAS and ODI scores. N ​= ​8 patients (21.6%) had to undergo subsequent surgery at the cranially adjacent level. The incidence of adjacent level disc degeneration and adjacent facet joint degeneration was 24.3% and 35.1%, respectively. More pronounced degenerative changes of the adjacent level discs (p ​= ​0.005) and facet joints (p ​= ​0.042) prior to surgery and a lower segmental lordosis reconstruction at the lumbosacral junction (p ​= ​0.0084) were identified as potential risk factors for the development of subsequent adjacent level pathologies. Discussion & ConclusionThe study revealed satisfactory clinical results at a mid-to long-term FU of ≥5 years. The incidence of adjacent level degeneration was higher than initially expected. Patients with preexisting radiographic signs of degenerative adjacent level changes have a higher risk for subsequent deterioration necessitating reoperation at the adjacent segment at later stages. Furthermore, adequate intraoperative segmental lordosis reconstruction at the index segment is paramount as the present data reveal this to be a key protective factor for adjacent segment preservation.

Comparison of the Effectiveness of Cervical Medial Branch Radiofrequency Ablation for Chronic Facet Joint Syndrome in Patients Selected by a Common Medial Branch Block Paradigm

Comparison of the Effectiveness of Cervical Medial Branch Radiofrequency Ablation for Chronic Facet Joint Syndrome in Patients Selected by a Common Medial Branch Block Paradigm

ОПЫТ ДЕРЕЦЕПЦИИ МЕЖПОЗВОНКОВЫХ СУСТАВОВ ПОЯСНИЧНОГО ОТДЕЛА ПОЗВОНОЧНИКА

In this paper, we studied the immediate and long-term results of denervation of intervertebral joints in 30 patients with pain syndrome in the lumbar spine. The criteria for exclusion from the study were-the presence of deformities and abnormalities of the spine, the presence of neurogenic intermittent claudication, signs of compression of neural structures, surgical intervention on the POP in the anamnesis. The catamnesis was collected in 18 patients in the period from 1.7 months to 18 months after surgery. Pain syndrome on a visually analog scale after surgery decreased by an average of 20–30 mm. Subclinically expressed anxiety/depression persists in all patients with a “good” treatment outcome, and the assessment was performed using the hospital Anxiety and Depression Scale (HADS). According to the Nurick scale, the results of treatment were estimated at level 2 (improvement) in 93.3% of cases (n = 28), level 3 (condition without changes) 6.7% of cases (n = 2). According to the results of the study, denervation of the intervertebral joints is an eff ective minimally invasive method of treating facet syndrome. It allows in the early and long-term postoperative periods to signifi cantly reduce the pain syndrome and improve the quality of life of patients. The authors also assume that back pain is polyethological, which requires careful selection of patients for this type of procedure

The effect of consecutive facet medial branch radiofrequency denervation and dorsal root ganglion pulse radiofrequency therapy on lumbar facet joint pain.

The aim of this study was to evaluate the efficacy of consecutive facet medial branch (FMB) radiofrequency denervation (RFD) and dorsal root ganglion pulse radiofrequency (DRG PRF) therapy in patients with chronic lumbar facet joint pain. The study included 27 patients with chronic lumbar pain who had ≥50% pain reduction after FMB block for suspected lumbar facet syndrome and subsequently underwent FMB RFD together with PRF to the adjacent DRG. The patients were retrospectively analyzed in terms of age, gender, pre-procedure symptom duration, history of previous back surgery, FMB RFD and DRG PRF level and side, and numerical rating scale scores immediately before and at 1, 3, and 6 months after the procedure, and subjective pain reduction at 6 months post-treatment. Treatment success was defined as ≥50% subjective pain reduction at 6 months. A total of 19 women and 8 men with a mean age of 57.7±12.4 years were analyzed. Twenty patients (74.1%) had no prior history of low back surgery. The success rate of the procedure in terms of subjective pain reduction at 6 months was 82.5% (n=25). The subjective percentage of pain reduction at post-procedure 6 months was significantly lower in patients with a pre-procedure symptom duration of 12 months or longer compared to those whose pre-procedure symptom duration was <12 months (p=0.04). Our study results show that the analgesic efficiency of DRG PRF added to FMD RFD treatment can be increased in patients with short symptom durations.