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Nikolai Bogduk - One of the best experts on this subject based on the ideXlab platform.
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systematic review of the effectiveness of lumbar medial branch thermal radiofrequency Neurotomy stratified for diagnostic methods and procedural technique
Pain Medicine, 2020Co-Authors: Byron J Schneider, Lisa Doan, Marc K Maes, Kevin R Martinez, Alan Gonzalez Cota, Nikolai BogdukAbstract:Objective To determine the effectiveness of lumbar medial branch thermal radiofrequency Neurotomy based on different selection criteria and procedural techniques. Design Comprehensive systematic review. Methods A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. Outcome measures The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following Neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief, as well as procedural technique with perpendicular or parallel placement of electrodes. Results Results varied by selection criteria and procedural technique. At six months, 26% of patients selected via single medial branch block with 50% pain relief and treated via perpendicular technique achieved at least 50% pain relief; 49% of patients selected via dual medial branch blocks with 50% pain relief and treated via parallel technique achieved at least 50% pain relief. The most rigorous patient selection and technique-two diagnostic medial branch blocks with 100% pain relief and parallel electrode placement-resulted in 56% of patients experiencing 100% relief of pain at six months. Conclusions This comprehensive systematic review found differences in the effectiveness of lumbar medial branch radiofrequency Neurotomy when studies were stratified by patient selection criteria and procedural technique. The best outcomes are achieved when patients are selected based on high degrees of pain relief from dual medial branch blocks with a technique employing parallel electrode placement.
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occipital headache
2016Co-Authors: J Govind, W King, B Bailey, Nikolai BogdukAbstract:Radiofrequency Neurotomy for the treatment of thir
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Study Design. A prospective audit.
2015Co-Authors: Jerry Mclarty, Nikolai BogdukAbstract:Objective. To establish the efficacy of lumbar medial branch Neurotomy under optimum conditions. Summary of Background Data. Previous reports of the efficacy of lumbar medial branch Neurotomy have been confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome. Methods. Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the lumbar zygapophysial joints, under-went lumbar medial branch Neurotomy. Before surgery, all were evaluated by visual analog scale and a variety of validated measures of pain, disability, and treatment sat-isfaction. Electromyography of the multifidus muscle was performed before and after surgery to ensure accuracy of the Neurotomy. All outcome measures were repeated at
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diagnosing lumbar zygapophysial joint pain
Pain Medicine, 2005Co-Authors: Nikolai BogdukAbstract: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 …
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efficacy and validity of radiofrequency Neurotomy for chronic lumbar zygapophysial joint pain
Spine, 2000Co-Authors: Paul Dreyfuss, Jerry Mclarty, Bobby Halbrook, Kevin Pauza, Anand B Joshi, Nikolai BogdukAbstract:Study design A prospective audit. Objective To establish the efficacy of lumbar medial branch Neurotomy under optimum conditions. Summary of background data Previous reports of the efficacy of lumbar medial branch Neurotomy have been confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome. Methods Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the lumbar zygapophysial joints, underwent lumbar medial branch Neurotomy. Before surgery, all were evaluated by visual analog scale and a variety of validated measures of pain, disability, and treatment satisfaction. Electromyography of the multifidus muscle was performed before and after surgery to ensure accuracy of the Neurotomy. All outcome measures were repeated at 6 weeks, and 3, 6, and 12 months after surgery. Results Some 60% of the patients obtained at least 90% relief of pain at 12 months, and 87% obtained at least 60% relief. Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated. Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome. Conclusions Lumbar medial branch Neurotomy is an effective means of reducing pain in patients carefully selected on the basis of controlled diagnostic blocks. Adequate coagulation of the target nerves can be achieved by carefully placing the electrode in correct position as judged radiologically. Electrical stimulation before lesioning is superfluous in assuring correct placement of the electrode.
M V Boswell - One of the best experts on this subject based on the ideXlab platform.
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a systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain
Pain Physician, 2015Co-Authors: Laxmaiah Manchikanti, M V Boswell, Sanjeeva Gupta, Alan D Kaye, Dharam P Mann, Sanjay Bakshi, Jay S Grider, Christopher Gharibo, Sunny Jha, Devi E NampiaparampilAbstract:BACKGROUND The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency Neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. OBJECTIVE To evaluate and update the clinical utility of therapeutic lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain. STUDY DESIGN A systematic review of therapeutic lumbar, cervical, and thoracic facet joint interventions for the treatment of chronic spinal pain. METHODS The available literature on lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane Musculoskeletal Review Group criteria and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational studies. The level of evidence was classified at 5 levels from Level I to Level V. Data sources included relevant literature identified through searches on PubMed and EMBASE from 1966 through March 2015, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption. RESULTS A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency Neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency Neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency Neurotomy for long-term improvement. LIMITATIONS The limitations of this systematic review include an overall paucity of high quality studies and more specifically the lack of investigations related to thoracic facet joint injections. CONCLUSION Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency Neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency Neurotomy.
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a systematic review of therapeutic facet joint interventions in chronic spinal pain
Pain Physician, 2007Co-Authors: M V Boswell, Nalini Sehgal, James Colson, Elmer E Dunbar, Richard S EpterAbstract:BACKGROUND: Facet joints are considered to be a common source of chronic spinal pain. Facet joint interventions, including intraarticular injections, medial branch nerve blocks, and Neurotomy (radiofrequency and cryoneurolysis) are used to manage chronic facet-mediated spinal pain. A systematic review of therapeutic facet interventions published in January 2005, concluded that facet interventions were variably effective for short-term and long-term relief of facet joint pain. OBJECTIVE: To provide an updated evaluation of the effectiveness of 3 types of facet joint interventions in managing chronic spinal pain. STUDY DESIGN: A systematic review utilizing criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and the Cochrane Musculoskeletal Review Group for randomized trials. METHODS: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (November 2004 to December 2006) and manual searches of bibliographies of known primary and review articles within the last 2 years. Results of the analyses were performed for the different modes of facet joint interventions for the cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with these procedures. OUTCOME MEASURES: The primary outcome measure was pain relief. For intraarticular facet joint injections and medial branch blocks, short-term pain relief was defined as relief lasting less than 6 weeks and long-term relief as 6 weeks or longer. For medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency Neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. RESULTS: For cervical intraarticular facet joint injections, the evidence is limited for short- and long-term pain relief. For lumbar intraarticular facet joint injections, the evidence is moderate for short- and long-term pain relief. For cervical, thoracic, and lumbar medial branch nerve blocks with local anesthetics (with or without steroids), the evidence is moderate for short- and long-term pain relief with repeat interventions. The evidence for pain relief with radiofrequency Neurotomy of cervical and lumbar medial branch nerves is moderate for short- and long-term pain relief, and indeterminate for thoracic facet Neurotomy. CONCLUSION: With intraarticular facet joint injections, the evidence for short- and long-term pain relief is limited for cervical pain and moderate for lumbar pain. For medial branch blocks, the evidence is moderate for short- and long-term pain relief. For medial branch Neurotomy, the evidence is moderate for short- and long-term pain relief.
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therapeutic facet joint interventions in chronic spinal pain a systematic review of effectiveness and complications
Pain Physician, 2005Co-Authors: M V Boswell, James Colson, William F SpillaneAbstract:BACKGROUND Facet joint interventions are used frequently for managing chronic spinal pain. Evidence continues to accumulate supporting the clinical effectiveness of these procedures and defining potential complications. OBJECTIVE To evaluate the effectiveness of three types of facet joint interventions (facet joint injections, medial branch blocks and facet joint Neurotomy) in managing spinal pain. STUDY DESIGN A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and Cochrane Musculoskeletal Review Group for randomized trials. METHODS Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (January 1966 to November 2004), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years. Analyses were performed for the different modes of facet joint interventions of cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with the procedures. OUTCOME MEASURES The primary outcome measure was pain relief. For facet joint injections and medial branch blocks, short-term pain relief was defined as relief less than 6 weeks, and long-term as 6 weeks or longer. For medial branch radiofrequency Neurotomy, short-term relief was defined as pain relief of less than 3 months, and long-term as 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. RESULTS For lumbar intraarticular facet joint injections, there was moderate evidence for short-term improvement, and limited evidence for long-term improvement. The evidence was negative for cervical intraarticular facet joint injections. For cervical and lumbar medial branch blocks with local anesthetics and steroids, the evidence was moderate. The evidence for pain relief with radiofrequency Neurotomy of medial branch nerves was moderate to strong. CONCLUSION The evidence for facet joint interventions ranged from negative to strong.
Alan D Kaye - One of the best experts on this subject based on the ideXlab platform.
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systematic review of cervical medial branch thermal radiofrequency Neurotomy is not based on peer review published methodology
Pain Medicine, 2016Co-Authors: Laxmaiah Manchikanti, Alan D Kaye, Joshua A HirschAbstract:Dear Editor, A systematic review with comprehensive analysis of published data of the effectiveness and risks of cervical medial branch thermal radiofrequency Neurotomy by Engel et al. [1] would appear to confuse several opinions with facts. The manuscript is based on a number of theories and standards developed by Dr. Bogduk, an important and major contributor to diagnosis and treatment of spinal disorders [2]. However, careful review of the manuscript demonstrates that these beliefs and concepts incorporated into ISIS standards, in our opinion, appear to have been published without appropriate validation and/or peer review [2]. As a consequence of these beliefs, Engel et al. do not include cervical radiofrequency Neurotomy procedures believed to have been done in ways that differ from those specified by Dr. Bogduk in their systematic review. We believe, therefore, this decision to be a significant …
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cervical zygapophysial facet joint pain effectiveness of interventional management strategies
Postgraduate Medicine, 2016Co-Authors: Alan D KayeAbstract:Diagnostic facet joint nerve blocks have been utilized in the diagnosis of cervical facet joint pain in patients without disk herniation or radicular pain due to a lack of reliable noninvasive diagnostic measures. Therapeutic interventions include intra-articular injections, facet joint nerve blocks and radiofrequency Neurotomy. The diagnostic accuracy and effectiveness of facet joint interventions have been assessed in multiple diagnostic accuracy studies, randomized controlled trials (RCTs), and systematic reviews in managing chronic neck pain. This assessment shows there is Level II evidence based on a total of 11 controlled diagnostic accuracy studies for diagnosing cervical facet joint pain in patients without disk herniation or radicular pain utilizing controlled diagnostic blocks. Due to significant variability and internal inconsistency regarding prevalence in a heterogenous population; despite 11 studies, evidence is determined as Level II. Prevalence ranged from 36% to 67% with at least 80% pain relief as the criterion standard with a false-positive rate ranging from 27% to 63%. The evidence is Level II for the long-term effectiveness of radiofrequency Neurotomy and facet joint nerve blocks in managing cervical facet joint pain. There is Level III evidence for cervical intra-articular injections.
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a systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain
Pain Physician, 2015Co-Authors: Laxmaiah Manchikanti, M V Boswell, Sanjeeva Gupta, Alan D Kaye, Dharam P Mann, Sanjay Bakshi, Jay S Grider, Christopher Gharibo, Sunny Jha, Devi E NampiaparampilAbstract:BACKGROUND The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency Neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. OBJECTIVE To evaluate and update the clinical utility of therapeutic lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain. STUDY DESIGN A systematic review of therapeutic lumbar, cervical, and thoracic facet joint interventions for the treatment of chronic spinal pain. METHODS The available literature on lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane Musculoskeletal Review Group criteria and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational studies. The level of evidence was classified at 5 levels from Level I to Level V. Data sources included relevant literature identified through searches on PubMed and EMBASE from 1966 through March 2015, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption. RESULTS A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency Neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency Neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency Neurotomy for long-term improvement. LIMITATIONS The limitations of this systematic review include an overall paucity of high quality studies and more specifically the lack of investigations related to thoracic facet joint injections. CONCLUSION Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency Neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency Neurotomy.
Laxmaiah Manchikanti - One of the best experts on this subject based on the ideXlab platform.
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systematic review of cervical medial branch thermal radiofrequency Neurotomy is not based on peer review published methodology
Pain Medicine, 2016Co-Authors: Laxmaiah Manchikanti, Alan D Kaye, Joshua A HirschAbstract:Dear Editor, A systematic review with comprehensive analysis of published data of the effectiveness and risks of cervical medial branch thermal radiofrequency Neurotomy by Engel et al. [1] would appear to confuse several opinions with facts. The manuscript is based on a number of theories and standards developed by Dr. Bogduk, an important and major contributor to diagnosis and treatment of spinal disorders [2]. However, careful review of the manuscript demonstrates that these beliefs and concepts incorporated into ISIS standards, in our opinion, appear to have been published without appropriate validation and/or peer review [2]. As a consequence of these beliefs, Engel et al. do not include cervical radiofrequency Neurotomy procedures believed to have been done in ways that differ from those specified by Dr. Bogduk in their systematic review. We believe, therefore, this decision to be a significant …
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a systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain
Pain Physician, 2015Co-Authors: Laxmaiah Manchikanti, M V Boswell, Sanjeeva Gupta, Alan D Kaye, Dharam P Mann, Sanjay Bakshi, Jay S Grider, Christopher Gharibo, Sunny Jha, Devi E NampiaparampilAbstract:BACKGROUND The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency Neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. OBJECTIVE To evaluate and update the clinical utility of therapeutic lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain. STUDY DESIGN A systematic review of therapeutic lumbar, cervical, and thoracic facet joint interventions for the treatment of chronic spinal pain. METHODS The available literature on lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane Musculoskeletal Review Group criteria and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational studies. The level of evidence was classified at 5 levels from Level I to Level V. Data sources included relevant literature identified through searches on PubMed and EMBASE from 1966 through March 2015, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption. RESULTS A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency Neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency Neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency Neurotomy for long-term improvement. LIMITATIONS The limitations of this systematic review include an overall paucity of high quality studies and more specifically the lack of investigations related to thoracic facet joint injections. CONCLUSION Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency Neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency Neurotomy.
Nalini Sehgal - One of the best experts on this subject based on the ideXlab platform.
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an update of the effectiveness of therapeutic lumbar facet joint interventions
Pain Physician, 2012Co-Authors: Frank J E Falco, Sukdeb Datta, Nalini Sehgal, Stephanie Geffert, Obi Onyewu, Jie Zhu, Sareta Coubarous, Mariam Hameed, Stephen P WardAbstract:BACKGROUND Therapeutic lumbar facet joint interventions are implemented to provide long-term pain relief after the facet joint has been identified as the basis for low back pain. The therapeutic lumbar facet joint interventions generally used for the treatment of low back pain of facet joint origin are intraarticular facet joint injections, lumbar facet joint nerve blocks, and radiofrequency Neurotomy. OBJECTIVE To evaluate and update the effect of therapeutic lumbar facet joint interventions in managing chronic low back pain. STUDY DESIGN A systematic review of therapeutic lumbar facet joint interventions for the treatment of chronic low back pain. METHODS The available literature on lumbar facet joint interventions in managing chronic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through June 2012, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES The primary outcome measure was pain relief with short-term relief defined as up to 6 months and long-term relief as 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS For this systematic review, 122 studies were identified. Of these, 11 randomized trials and 14 observational studies met inclusion criteria for methodological quality assessment. The evidence for radiofrequency Neurotomy is good and fair to good for lumbar facet joint nerve blocks for short- and long-term improvement; whereas the evidence for intraarticular injections and pulsed radiofrequency Neurotomy is limited. LIMITATIONS The limitations of this systematic review include the continued paucity of evidence, specifically for intraarticular injection therapy. CONCLUSION In summary, there is good evidence for the use of conventional radiofrequency Neurotomy, and fair to good evidence for lumbar facet joint nerve blocks for the treatment of chronic lumbar facet joint pain resulting in short-term and long-term pain relief and functional improvement. There is limited evidence for intraarticular facet joint injections and pulsed radiofrequency thermoneurolysis.
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a systematic review of therapeutic facet joint interventions in chronic spinal pain
Pain Physician, 2007Co-Authors: M V Boswell, Nalini Sehgal, James Colson, Elmer E Dunbar, Richard S EpterAbstract:BACKGROUND: Facet joints are considered to be a common source of chronic spinal pain. Facet joint interventions, including intraarticular injections, medial branch nerve blocks, and Neurotomy (radiofrequency and cryoneurolysis) are used to manage chronic facet-mediated spinal pain. A systematic review of therapeutic facet interventions published in January 2005, concluded that facet interventions were variably effective for short-term and long-term relief of facet joint pain. OBJECTIVE: To provide an updated evaluation of the effectiveness of 3 types of facet joint interventions in managing chronic spinal pain. STUDY DESIGN: A systematic review utilizing criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and the Cochrane Musculoskeletal Review Group for randomized trials. METHODS: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (November 2004 to December 2006) and manual searches of bibliographies of known primary and review articles within the last 2 years. Results of the analyses were performed for the different modes of facet joint interventions for the cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with these procedures. OUTCOME MEASURES: The primary outcome measure was pain relief. For intraarticular facet joint injections and medial branch blocks, short-term pain relief was defined as relief lasting less than 6 weeks and long-term relief as 6 weeks or longer. For medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency Neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. RESULTS: For cervical intraarticular facet joint injections, the evidence is limited for short- and long-term pain relief. For lumbar intraarticular facet joint injections, the evidence is moderate for short- and long-term pain relief. For cervical, thoracic, and lumbar medial branch nerve blocks with local anesthetics (with or without steroids), the evidence is moderate for short- and long-term pain relief with repeat interventions. The evidence for pain relief with radiofrequency Neurotomy of cervical and lumbar medial branch nerves is moderate for short- and long-term pain relief, and indeterminate for thoracic facet Neurotomy. CONCLUSION: With intraarticular facet joint injections, the evidence for short- and long-term pain relief is limited for cervical pain and moderate for lumbar pain. For medial branch blocks, the evidence is moderate for short- and long-term pain relief. For medial branch Neurotomy, the evidence is moderate for short- and long-term pain relief.