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Nikolai Bogduk - One of the best experts on this subject based on the ideXlab platform.
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percutaneous radio frequency neurotomy for chronic cervical Zygapophyseal Joint pain
The New England Journal of Medicine, 1996Co-Authors: Susan M Lord, Leslie Barnsley, Barbara J Wallis, Gregory J Mcdonald, Nikolai BogdukAbstract:Background Chronic pain in the cervical Zygapophyseal Joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful Joint, but the efficacy of this treatment has not been established. Methods In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80°C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical Zygapophyseal Joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews...
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the value of the provocation response in lumbar Zygapophyseal Joint injections
The Clinical Journal of Pain, 1994Co-Authors: Anthony C Schwarzer, Charles Aprill, Richard Derby, Joseph Fortin, Garrett Kine, Nikolai BogdukAbstract:OBJECTIVE To determine the relationship between pain provocation and the analgesic response in lumbar Zygapophyseal Joint blocks. DESIGN Consecutive patients undergoing intraarticular Zygapophyseal Joint blocks for the investigation of low back pain were included in this prospective study. SETTING The referred sample was from the metropolitan areas of New Orleans and San Francisco. PATIENTS Ninety patients with low back pain of > 3 months' duration and no history of lumbar surgery. INTERVENTIONS All patients underwent one or more intraarticular injections of radiographic contrast followed by lignocaine (lidocaine) 2% into Zygapophyseal Joints between L2-3 and L5-S1. Those with definite responses at one or more levels underwent confirmatory blocks using 0.5% bupivacaine. OUTCOME MEASURES Provocation of familiar pain and relief of pain after the injection of local anesthetic. Patients were assessed by an independent observer. RESULTS A total of 203 Joints were studied. Adopting liberal criteria, either exact or similar reproduction of pain on the one hand correlated with either definite or complete relief of pain after a single, analgesic block on the other (p < 0.0001). However, when more stringent criteria were adopted, such as response to a confirmatory block using bupivacaine, there was no significant association. CONCLUSIONS This study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar Zygapophyseal Joint blocks.
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the relative contributions of the disc and Zygapophyseal Joint in chronic low back pain
Spine, 1994Co-Authors: Anthony C Schwarzer, Charles Aprill, Richard Derby, Joseph Fortin, Garrett Kine, Nikolai BogdukAbstract:Study Design.A prospective cross-sectional analytic approach was taken.Objectives.This study sought to determine the relative contribution of the disc and the Zygapophyseal Joint as a pain source in patients with chronic low back pain.Summary of Background Data.Previous studies have employed either
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medial branch blocks are specific for the diagnosis of cervical Zygapophyseal Joint pain
Regional anesthesia, 1993Co-Authors: Les Barnsley, Nikolai BogdukAbstract:Background and Objectives. To determine the specificity of cervical medial branch blocks for the diagnosis of cervical Zygapophyseal Joint pain by ascertaining the disposition of the local anesthetic after injection of the medial branches of the cervical dorsal rami. Methods. Sixteen consecutive patients with chronic neck pain from motor vehicle accidents underwent cervical medial branch blocks. A 22-gauge, 90-mm spinal needle was placed onto the target nerve under image-intensifier guidance. Immediately after each target nerve had been infiltrated with 0.5 ml of local anesthetic, 0.5 ml of contrast medium was injected to map the spread of injectate. Radiographs were recorded to document the pattern of spread. Results. Twenty-five injections of local anesthetic and contrast medium were performed. Contrast medium dispersed in characteristic patterns at all vertebral levels and always incorporated at least 5 mm of the perceived course of the target nerve. There was never any spread to the ventral ramus, beyond the medial fibers of semispinalis capitis or to the adjacent medial branches. No other single structure was consistently within the field of the contrast. Eleven patients obtained complete or definite relief of their pain, which could only be attributed to anesthetization of the Zygapophyseal Joint innervated by the nerves blocked. Conclusions. Local anesthetic blocks of the cervical medial branches are a specific test for the diagnosis of cervical Zygapophyseal Joint pain. The local anesthetic always reaches the target nerve and does not affect any other diagnostically important structures.
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the prevalence of cervical Zygapophyseal Joint pain a first approximation
Spine, 1992Co-Authors: Charles Aprill, Nikolai BogdukAbstract:A null hypothesis was tested to the effect that cervical Zygapophyseal Joint pain was uncommon. The prospectively recorded responses were reviewed of 318 consecutive patients with intractable neck pain who underwent provocation discography and cervical Zygapophyseal Joint blocks. Symptomatic Zygapophyseal Joints were encountered in 25% of the sample with a possibility that a further 38% suffered Zygapophyseal pain but were not appropriately investigated. The null hypothesis was rejected. Cervical Zygapophyseal Joint pain is not rare, and is worthy of further consideration not just in research but in clinical practice.
Cesar Fernandezdelaspenas - One of the best experts on this subject based on the ideXlab platform.
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short term changes in neck pain widespread pressure pain sensitivity and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain a randomized clinical trial
Journal of Orthopaedic & Sports Physical Therapy, 2014Co-Authors: Maria J Mejutovazquez, Ricardo Ortegasantiago, Jaime Salommoreno, Sebastian Truyolsdominguez, Cesar FernandezdelaspenasAbstract:Study Design Randomized clinical trial. Objectives To determine the effects of trigger point dry needling (TrPDN) on neck pain, widespread pressure pain sensitivity, and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle. Background TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes. Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed. Methods Seventeen patients (53% female) were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5–6 Zygapophyseal Joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses...
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immediate changes in widespread pressure pain sensitivity neck pain and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain a randomized clinical trial
Journal of Orthopaedic & Sports Physical Therapy, 2012Co-Authors: Raquel Martinezsegura, Ana I Delallaverincon, Ricardo Ortegasantiago, Joshua A Cleland, Cesar FernandezdelaspenasAbstract:Study Design Randomized clinical trial. Objectives To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM). Background Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity. Methods Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5–6 Zygapophyseal Joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 ...
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bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder evidence of impairment in central nociceptive processing
The Journal of Pain, 2009Co-Authors: Cesar Fernandezdelaspenas, Josue Fernandezcarnero, Lars Arendtnielsen, Fernando Galandelrio, Jorge Pesquera, Peter SvenssonAbstract:UNLABELLED: Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and Joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 Zygapophyseal Joint, the lateral pole of the temporo mandibular Joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 Zygapophyseal Joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P < .001). There were no significant differences in the magnitude of PPT decreases between the trigeminal and extratrigeminal test sites. PPT over the mental nerve, the TMJ, C5-C6 Zygapophyseal Joint and tibialis anterior muscle were negatively correlated to both duration of pain symptoms and TMD pain intensity (P < .05). Our findings revealed bilateral, widespread pressure hypersensitivity in women presenting with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD women. PERSPECTIVE: This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.
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bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder evidence of impairment in central nociceptive processing
The Journal of Pain, 2009Co-Authors: Cesar Fernandezdelaspenas, Josue Fernandezcarnero, Lars Arendtnielsen, Fernando Galandelrio, Jorge Pesquera, Peter SvenssonAbstract:Abstract Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and Joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 Zygapophyseal Joint, the lateral pole of the temporo mandibular Joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 Zygapophyseal Joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P P Perspective This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.
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bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome evidence of central processing in unilateral neuropathy
Brain, 2009Co-Authors: Cesar Fernandezdelaspenas, Ana Isabel De La Llaverincon, Josue Fernandezcarnero, M L Cuadrado, Lars ArendtnielsenAbstract:The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 Zygapophyseal Joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 Zygapophyseal Joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.
Peter Svensson - One of the best experts on this subject based on the ideXlab platform.
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bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder evidence of impairment in central nociceptive processing
The Journal of Pain, 2009Co-Authors: Cesar Fernandezdelaspenas, Josue Fernandezcarnero, Lars Arendtnielsen, Fernando Galandelrio, Jorge Pesquera, Peter SvenssonAbstract:UNLABELLED: Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and Joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 Zygapophyseal Joint, the lateral pole of the temporo mandibular Joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 Zygapophyseal Joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P < .001). There were no significant differences in the magnitude of PPT decreases between the trigeminal and extratrigeminal test sites. PPT over the mental nerve, the TMJ, C5-C6 Zygapophyseal Joint and tibialis anterior muscle were negatively correlated to both duration of pain symptoms and TMD pain intensity (P < .05). Our findings revealed bilateral, widespread pressure hypersensitivity in women presenting with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD women. PERSPECTIVE: This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.
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bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder evidence of impairment in central nociceptive processing
The Journal of Pain, 2009Co-Authors: Cesar Fernandezdelaspenas, Josue Fernandezcarnero, Lars Arendtnielsen, Fernando Galandelrio, Jorge Pesquera, Peter SvenssonAbstract:Abstract Our aim was to investigate bilateral, widespread pressure-pain hypersensitivity in nerve, muscle, and Joint tissues in women with myofascial temporomandibular disorders (TMD) without concomitant comorbid conditions. Twenty women with myofascial TMD (aged 20 to 28 years old), and 20 healthy matched women (aged 20 to 29 years), were recruited. Pressure-pain thresholds (PPT) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3) nerves, median (C5), radial (C6) and ulnar (C7) nerve trunks, the C5-C6 Zygapophyseal Joint, the lateral pole of the temporo mandibular Joint (TMJ), and the tibialis anterior muscle in a blinded design. The results showed that PPTs were significantly decreased bilaterally over the supra-orbital, infra-orbital, and mental nerves, median, ulnar, and radial nerve trunks, the lateral pole of the TMJ, the C5-C6 Zygapophyseal Joint, and the tibialis anterior muscle in patients with myofascial TMD as compared to healthy controls (all sites: P P Perspective This article reveals the presence of bilateral and widespread pressure-pain hypersensitivity in women with myofascial TMD, suggesting that widespread central sensitization is involved in myofascial TMD. This finding has implications for development of management strategies.
Charles Aprill - One of the best experts on this subject based on the ideXlab platform.
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clinical predictors of screening lumbar Zygapophyseal Joint blocks development of clinical prediction rules
The Spine Journal, 2006Co-Authors: Mark Laslett, Charles Aprill, Barry Mcdonald, Hans Tropp, Birgitta ObergAbstract:BACKGROUND: Only controlled intra-articular Zygapophyseal Joint (ZJ) injections or medial branch blocks can diagnose ZJ-mediated low back pain. The low prevalence of ZJ pain implies that identification of clinical predictors of a positive response to a screening block is needed. PURPOSE: To estimate the predictive power of clinical findings in relation to pain reduction after screening ZJ blocks. STUDY DESIGN: As part of a wider prospective blinded study investigating diagnostic accuracy of clinical variables, a secondary analysis was carried out to seek evidence of variables potentially valuable as predictors of screening ZJ block outcomes. PATIENT SAMPLE: Chronic low back pain patients received screening ZJ blocks (n5151) with 120 patients included in the analysis after exclusions. OUTCOME MEASURES: Pain intensity was measured using a 100-mm visual analog scale, and responses were categorized according to 75% through 95% or more pain reduction in 5% increments. METHODS: Patients completed pain drawings, questionnaires, and a clinical examination before screening lumbar ZJ blocks. History, demographic and clinical variables were evaluated in cross tabulation and regression analyses with diagnostic accuracy values calculated for variables and variable clusters in relation to different pain reduction standards. RESULTS: At the 75% pain reduction standard, 24.5% responded to screening ZJ blocks and 10.8% responded at the 95% standard. The centralization phenomenon is not associated with pain reduction using any standard. No variables were useful predictors of post‐ZJ block pain reduction of less than 90%. Seven clinical findings were associated with 95% pain reduction after blocks. Five useful clinical prediction rules (CPRs) were found for ruling out a 95% pain reduction (100% sensitivity), and one CPR had a likelihood ratio of 9.7, producing a fivefold improvement in posttest probability. CONCLUSIONS: A negative extension rotation test, the centralization phenomenon, and four CPRs effectively rule out pain ablation after screening ZJ block. One CPR generates a fivefold improvement in posttest probability of a negative or positive response to ZJ block. 2006 Elsevier Inc. All rights reserved.
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the value of the provocation response in lumbar Zygapophyseal Joint injections
The Clinical Journal of Pain, 1994Co-Authors: Anthony C Schwarzer, Charles Aprill, Richard Derby, Joseph Fortin, Garrett Kine, Nikolai BogdukAbstract:OBJECTIVE To determine the relationship between pain provocation and the analgesic response in lumbar Zygapophyseal Joint blocks. DESIGN Consecutive patients undergoing intraarticular Zygapophyseal Joint blocks for the investigation of low back pain were included in this prospective study. SETTING The referred sample was from the metropolitan areas of New Orleans and San Francisco. PATIENTS Ninety patients with low back pain of > 3 months' duration and no history of lumbar surgery. INTERVENTIONS All patients underwent one or more intraarticular injections of radiographic contrast followed by lignocaine (lidocaine) 2% into Zygapophyseal Joints between L2-3 and L5-S1. Those with definite responses at one or more levels underwent confirmatory blocks using 0.5% bupivacaine. OUTCOME MEASURES Provocation of familiar pain and relief of pain after the injection of local anesthetic. Patients were assessed by an independent observer. RESULTS A total of 203 Joints were studied. Adopting liberal criteria, either exact or similar reproduction of pain on the one hand correlated with either definite or complete relief of pain after a single, analgesic block on the other (p < 0.0001). However, when more stringent criteria were adopted, such as response to a confirmatory block using bupivacaine, there was no significant association. CONCLUSIONS This study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar Zygapophyseal Joint blocks.
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the relative contributions of the disc and Zygapophyseal Joint in chronic low back pain
Spine, 1994Co-Authors: Anthony C Schwarzer, Charles Aprill, Richard Derby, Joseph Fortin, Garrett Kine, Nikolai BogdukAbstract:Study Design.A prospective cross-sectional analytic approach was taken.Objectives.This study sought to determine the relative contribution of the disc and the Zygapophyseal Joint as a pain source in patients with chronic low back pain.Summary of Background Data.Previous studies have employed either
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the prevalence of cervical Zygapophyseal Joint pain a first approximation
Spine, 1992Co-Authors: Charles Aprill, Nikolai BogdukAbstract:A null hypothesis was tested to the effect that cervical Zygapophyseal Joint pain was uncommon. The prospectively recorded responses were reviewed of 318 consecutive patients with intractable neck pain who underwent provocation discography and cervical Zygapophyseal Joint blocks. Symptomatic Zygapophyseal Joints were encountered in 25% of the sample with a possibility that a further 38% suffered Zygapophyseal pain but were not appropriately investigated. The null hypothesis was rejected. Cervical Zygapophyseal Joint pain is not rare, and is worthy of further consideration not just in research but in clinical practice.
Gregory E Lutz - One of the best experts on this subject based on the ideXlab platform.
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percutaneous rupture of Zygapophyseal Joint synovial cysts a prospective assessment of nonsurgical management
Pm&r, 2018Co-Authors: Gregory E Lutz, Michael R Nicoletti, George E Cyril, Julian R Harrison, Christopher Lutz, Jennifer L Solomon, Paul M Cooke, James F Wyss, Richard J Herzog, Peter J MoleyAbstract:Abstract Background Although lumbar Zygapophyseal Joint synovial cysts are fairly well recognized, they are an uncommon cause of lumbosacral radicular pain. Nonoperative treatments include percutaneous aspiration of the cysts under computed tomography or fluoroscopic guidance with a subsequent corticosteroid injection. However, there are mixed results in terms of long-term outcomes and cyst reoccurrence. This study prospectively evaluates percutaneous ruptures of Zygapophyseal Joint (Z-Joint) synovial cysts for the treatment of lumbosacral radicular pain. Objectives Primary: To determine whether percutaneous rupture of symptomatic Z-Joint synovial cysts leads to sustained improvements in radicular pain and function. Secondary: To assess the rates of cyst recurrence and progression to surgical intervention following percutaneous rupture of symptomatic Z-Joint synovial cysts. Design Prospective cohort study. Setting Outpatient academic spine practice. Participants Adults with primary radicular pain due to a facet synovial cyst. Methods Participants underwent fluoroscopically guided percutaneous Z-Joint synovial cyst ruptures under standard-of-care practice. Data on pain, physical function, satisfaction, and progression to surgery were collected at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year after rupture. An intention-to-treat analysis was used for assessment of patient-reported outcome measures. Main Outcome Measures The Numerical Rating Scale, Oswestry Disability Index, and modified North American Spine Society questionnaires were used to measure pain, function, and satisfaction with the procedure, respectively. Results Thirty-five participants were included in the study, and data were analyzed by an independent researcher. Statistically significant changes in Oswestry Disability Index were reported at 2 weeks, 3 months, and 1 year postintervention ( P = .034, .040, and .039, respectively). A statistically and clinically significant relief of current pain was reported at 2 weeks ( P = .025) and 6 weeks ( P = .014) with respect to baseline. Patients showed significant improvements for best pain at 6 weeks with respect to baseline ( P = .031). Patients' worst pain showed the greatest amount of improvement with clinically meaningful changes at all time points compared with baseline. Patient-reported satisfaction was found nearly 70% of the time at all time points. Forty percent (14/35) of participants required repeat cyst rupture, and 31% (11/35) required surgical interventions. Conclusions There were statistically and clinically significant improvements in pain and function after percutaneous rupture of Z-Joint synovial cysts. In addition, the outcomes support previous retrospective studies indicating that approximately 40% of patients will need surgery. This study provides further research to determine the utility of this procedure and to precisely define a subset of ideal candidates. Level of Evidence Level II.
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fluoroscopic percutaneous lumbar Zygapophyseal Joint cyst rupture a clinical outcome study
The Spine Journal, 2008Co-Authors: Tracy L Allen, Yusuf Tatli, Gregory E LutzAbstract:Abstract Background context Lumbar Zygapophyseal Joint (Z-Joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-Joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture. Purpose To evaluate the therapeutic value and safety of Z-Joint cyst rupture in symptomatic patients. Study design/setting Retrospective cohort study in an academic outpatient physiatric spine practice. Patient sample Thirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46–86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6–24). Outcome measures Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention. Methods Patients with symptomatic lumbar Z-Joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-Joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet Joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients. Results Excellent long-term (average follow-up 1 y; range, 6–24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p Conclusions Fluoroscopic percutaneous Z-Joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.
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poster 57 anomolous ossicle of the lumbar Zygapophyseal Joint as a source of back pain in a gymnast a case report1
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Peter J Moley, Gregory E Lutz, Oheneba BoachieadjeiAbstract:Abstract Setting: University-based physician’s office. Patient: A 13-year-old gymnast who was in good spinal health until she was a restrained front-seat passenger in an automobile collision. Case Description: She had immediate onset of severe low back pain (LBP) that became chronic and limited her ability to participate in athletic activities. She was seen for a consultation due to the refractory nature of her condition. Assessment/Results: Physical examination was significant for pain with extension to the right and the neurologic examination was nonfocal. We obtained radiographs that included standing anteroposterior (AP), lateral, and flexion and extension views of the spine. AP views were significant for a bony defect of the right L3 inferior Zygapophyseal Joint. We obtained a new magnetic resonance imaging, which confirmed the bony defect of the right L3 inferior Zygapophyseal Joint on coronal views. A diagnostic fluoroscopic injection of 0.5mL of 2% lidocaine (Xylocaine) was performed. During the anesthetic phase, she had 100% pain relief and was able to perform spinal extension without return of her symptoms. The patient later underwent a resection of the ossicle and is now pain free. Discussion: LBP has been increasingly recognized as a problem of adolescents as well as adults. Back pain can pose a diagnostic dilemma to the physician trying to determine the specific pain generator. In the event of acute traumatic events or chronic LBP, obtaining radiographic information can be useful in such cases as spondylolysis, scoliosis, and acute fractures. Conclusion: This case underscores the importance of correlating patient history, physical exam, and pain drawings to the appropriate imaging studies. When doubt of diagnosis exists, a fluoroscopically guided injection of anesthetic to the suspected source of the pain may be required to corroborate the evidence.
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role of radiofrequency denervation in lumbar Zygapophyseal Joint synovitis in baseball pitchers a clinical experience
Pain Physician, 2003Co-Authors: Vijay B Vad, Gregory E Lutz, William G Cano, Dilshaad Basrai, Atul L BhatAbstract:Lumbar Zygapophyseal Joints have long been considered a source of low back pain with or without leg pain. The objective of this prospective study was to investigate the therapeutic effectiveness of lumbar Zygapophyseal Joint radiofrequency denervation (RFD) followed by physical therapy, for the treatment of refractory lumbar Zygapophyseal Joint mediated low back pain secondary to lumbar Zygapophyseal Joint synovitis, in baseball pitchers. Participants included twelve male baseball pitchers with a diagnosis of lumbar Zygapophyseal Joint synovitis mediated low back pain and a subsequent difficulty in pitching. These athletes underwent a trial of treatment, including oral anti-inflammatory medication, physical therapy, osteopathic manipulations, and fluoroscopically guided intra-articular Zygapophyseal Joint injection utilizing steroid and local anesthetic agent. Failure to progress led to these athletes receiving percutaneous, fluoroscopically-guided, radiofrequency denervation of the bilateral L 4-L5 and L5-S1 Zygapophyseal Joints. A good response to a diagnostic medial branch block was a prerequisite for RFD treatment. In all cases, the medial branch above and below the involved level was treated. Post procedure, all athletes participated in a phased physical therapy program followed by a progressive return to pitching. Success was defined as the ability to return to pre-procedure level of baseball pitching combined with greater than 50% low back pain reduction. Pre- and post-RFD, Visual Analog (Numeric) Scale (VAS) and Roland-Morris (R-M) tests were administered. Ten out of 12 (83%) athletes were able to return to pitching at a level attained prior to RFD. All 12 patients, experienced statistically significant low back pain relief, with a mean pre-RFD VAS of 8.4; mean post-RFD VAS of 1.7; mean pre-RFD R-M score of 12.3; and mean post-RFD R-M score of 22.3. In conclusion, athletes, experiencing lumbar Zygapophyseal Joint mediated low back pain secondary to Zygapophyseal Joint synovitis and have failed more conservative management may benefit from radiofrequency Zygapophyseal Joint denervation followed by a formal rehabilitation program.
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fluoroscopically guided aspiration of a symptomatic lumbar Zygapophyseal Joint cyst a case report
Archives of Physical Medicine and Rehabilitation, 2002Co-Authors: Gregory E Lutz, Timothy ShenAbstract:Lumbar Zygapophyseal Joint cysts are potential pain generators in patients with axial pain and/or lower-limb radicular pain. The traditional treatment of symptomatic cysts that do not respond to conservative measures is surgical decompression. Percutaneous needle aspiration under fluoroscopic guidance is a potential minimally invasive treatment option. We present a patient with a large symptomatic L4-5 Zygapophyseal Joint cyst and right L5 radiculopathy who responded well to percutaneous aspiration.
