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Nikolai Bogduk - One of the best experts on this subject based on the ideXlab platform.
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The Prevalence of "Pure" Lumbar Zygapophysial Joint Pain in Patients with Chronic Low Back Pain.
Pain medicine (Malden Mass.), 2020Co-Authors: John Macvicar, Ann Marguerite Macvicar, Nikolai BogdukAbstract:BACKGROUND Estimates of the prevalence of lumbar Zygapophysial Joint (Z Joint) pain differ in the literature, as do case definitions for this condition. No studies have determined the prevalence of "pure" lumbar Z Joint pain, defined as complete relief of pain following placebo-controlled diagnostic blocks. OBJECTIVE The objective of this study was to estimate the prevalence of "pure" lumbar Z Joint pain. METHODS In a private practice setting, 206 patients with possible lumbar Z Joint pain underwent controlled diagnostic blocks using one of two protocols: placebo-controlled comparative blocks and fully randomized, placebo-controlled, triple blocks. RESULTS In the combined sample, the prevalence of "pure" lumbar Z Joint pain was 15% (10-20%). CONCLUSIONS The prevalence of "pure" lumbar Z Joint pain is substantially and significantly less than most of the prevalence estimates of lumbar Z Joint pain reported in the literature.
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The role of tissue damage in whiplash-associated disorders: discussion paper 1.
Spine, 2011Co-Authors: Michele Curatolo, Nikolai Bogduk, Paul C. Ivancic, Samuel A. Mclean, Gunter P. Siegmund, Beth A. WinkelsteinAbstract:predicted by bioengineering studies and validated through animal studies; for Zygapophysial Joint pain, a valid diagnostic test and a proven treatment are available. Lesions of dorsal root ganglia, discs, ligaments, muscles, and vertebral artery have been documented in biomechanical and autopsy studies, but no valid diagnostic test is available to assess their clinical relevance. The proportion of WAD patients in whom a persistent lesion is the major determinant of ongoing symptoms is unknown. Psychosocial factors, stress reactions, and generalized hyperalgesia have also been shown to predict WAD outcomes. Conclusion. There is evidence supporting a lesion-based model in WAD. Lack of macroscopically identifi able tissue damage does not rule out the presence of painful lesions. The best available evidence concerns Zygapophysial Joint pain. The clinical relevance of other lesions needs to be addressed by future research.
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On cervical Zygapophysial Joint pain after whiplash.
Spine, 2011Co-Authors: Nikolai BogdukAbstract:Study Design. Narrative review.Objective. To summarise the evidence that implicates the cervical Zygapophysial Joints as the leading source of chronic neck pain after whiplash.Summary of Background Data. Reputedly a patho-anatomic basis for neck pain after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case.Methods. Data were retrieved from studies that addressed the post-mortem features and biomechanics of injury to the cervical Zygapophysial Joints, and from clinical studies of the diagnosis and treatment of Zygapophysial Joint pain, to illustrate convergent validity.Results. Post-mortem studies show that a spectrum of injuries can befall the Zygapophysial Joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries.Clinical studies have shown that Zygapophysial Joint pain is very common amongst patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy.Conclusion. The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical Zygapophysial Joints as a site of injury and source of pain, strongly implicates injury to these Joints as a common basis for chronic neck pain after whiplash. Language: en
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Diagnostic blocks for chronic pain
Scandinavian journal of pain, 2010Co-Authors: Michele Curatolo, Nikolai BogdukAbstract:Many conditions associated with chronic pain have no detectable morphological correlate. Consequently, the source of pain cannot be established by clinical examination or medical imaging. However, for some such conditions, the source of pain can be established using diagnostic blocks. The aim of this paper is to review the available evidence concerning the validity and utility of diagnostic blocks, and to identify areas where research is needed. Diagnostic blocks for cervical and lumbar Zygapophysial Joint pain have been extensively studied. Single blocks are associated with about 30% false-positive responses. Patients can report relief of pain for reasons other than the effect of a local anaesthetic injected during a diagnostic block, e.g. as the result of placebo effect. Therefore, in order to be valid, diagnostic blocks must be controlled in each patient. Many practitioners find limitations in the clinical applicability of placebo-controlled blocks. Comparative blocks (comparison lidocaine-bupivacaine for each block within each patient) have been investigated as alternatives to placebo-controlled blocks. A positive response requires short-lasting relief when lidocaine is used, and long-lasting relief when bupivacaine is used. The validity of comparative blocks is high when the disease under investigation is common. This is the case for Zygapophysial Joint pain after whiplash injury. However, the validity of comparative blocks strongly decreases with decreasing prevalence of the condition. This is the case for lumbar Zygapophysial Joint pain in young subjects: in these patients, the expected false-positive rate with comparative blocks is unacceptably high. Diagnostic blocks for cervical and lumbar Zygapophysial Joint have therapeutic utility. When positive, radiofrequency denervation is expected to produce substantial pain relief in 60-80% of patients. For all other types of blocks, very little research has been conducted. The few studies that have been published did not use controlled blocks. This may have produced a high rate of false-positive responses. Some data on spinal nerve root blocks suggest that these procedures may be valid for the diagnosis of radicular pain and are perhaps predictive for the success of surgery. The validity of diagnostic sympathetic blocks and their prognostic value in relation to outcomes of sympathectomy are unclear. There is lack of data on the validity of diagnostic intra-articular blocks. Discogenic pain is typically diagnosed by provocative discography, but this procedure remains controversial. Intradiscal and sinuvertebral nerve blocks with local anaesthetics are possible alternatives to provocation discography. At present, the sparse data available on these procedures do not allow an estimation of their validity. In conclusion, nerve blocks have an important potential role in the management of chronic pain. These procedures are not suitable to identify the pathology that is the cause of the pain (e.g. inflammatory, neuropathic, etc.). However, they can reveal the anatomical source of pain, thereby allowing the development of targeted treatments. Unfortunately, there is currently very little research on the validity and prognostic value of blocks. The potential usefulness of this practice remains therefore largely unexplored.
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On diagnostic blocks for lumbar Zygapophysial Joint pain.
F1000 medicine reports, 2010Co-Authors: Nikolai BogdukAbstract:Diagnostic blocks are used to identify patients with back pain stemming from their lumbar Zygapophysial Joints. Single, diagnostic blocks have an unacceptably high false positive rate. As well, comparative local anaesthetic blocks lack validity because the prevalence of the condition is low. Relying on 50% relief following single-diagnostic blocks does not provide a valid diagnosis. Placebo-controlled blocks are the only available valid means of establishing a diagnosis of lumbar Zygapophysial Joint pain.
Michele Curatolo - One of the best experts on this subject based on the ideXlab platform.
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spine section original research article a shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
2016Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Objective. Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60–70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2–4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method. Interventions. We prospectively studied 15 consecutive patients with diagnosed cervical Zygapophysial Joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the Joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment. Results. Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80–100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70–100%) and 6 patients (40%, 95% CI 15–65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes. Conclusion. In patients with cervical Zygapophysial Joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique.
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Accuracy of ultrasound-guided nerve blocks of the cervical Zygapophysial Joints.
Anesthesiology, 2012Co-Authors: Andreas Siegenthaler, Michele Curatolo, Sabine Mlekusch, Sven Trelle, Juerg Schliessbach, Urs EichenbergerAbstract:Cervical Zygapophysial Joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical Zygapophysial Joints using fluoroscopy as control.
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a shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
Pain Medicine, 2011Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60-70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2-4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method.
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The role of tissue damage in whiplash-associated disorders: discussion paper 1.
Spine, 2011Co-Authors: Michele Curatolo, Nikolai Bogduk, Paul C. Ivancic, Samuel A. Mclean, Gunter P. Siegmund, Beth A. WinkelsteinAbstract:predicted by bioengineering studies and validated through animal studies; for Zygapophysial Joint pain, a valid diagnostic test and a proven treatment are available. Lesions of dorsal root ganglia, discs, ligaments, muscles, and vertebral artery have been documented in biomechanical and autopsy studies, but no valid diagnostic test is available to assess their clinical relevance. The proportion of WAD patients in whom a persistent lesion is the major determinant of ongoing symptoms is unknown. Psychosocial factors, stress reactions, and generalized hyperalgesia have also been shown to predict WAD outcomes. Conclusion. There is evidence supporting a lesion-based model in WAD. Lack of macroscopically identifi able tissue damage does not rule out the presence of painful lesions. The best available evidence concerns Zygapophysial Joint pain. The clinical relevance of other lesions needs to be addressed by future research.
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A shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
Pain medicine (Malden Mass.), 2011Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60-70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2-4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method. We prospectively studied 15 consecutive patients with diagnosed cervical Zygapophysial Joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the Joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment. Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80-100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70-100%) and 6 patients (40%, 95% CI 15-65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes. In patients with cervical Zygapophysial Joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique. Wiley Periodicals, Inc.
Susan M. Lord - One of the best experts on this subject based on the ideXlab platform.
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cervical Zygapophysial Joint pain
Neurosurgery Quarterly, 1998Co-Authors: Nikolai Bogduk, Susan M. LordAbstract:SummaryThe role of the cervical Zygapophysial Joints as sources of chronic neck pain has attracted considerable attention and some controversy. Cervical Zygapophysial Joints are typical synovial Joints and are innervated by the medial branches of the cervical dorsal rami. Stimulation of these Joints
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Percutaneous Radiofrequency Neurotomy of the Cervical Medial Branches: A Validated Treatment for Cervical Zygapophysial Joint Pain
Neurosurgery Quarterly, 1998Co-Authors: Susan M. Lord, Gregory J. Mcdonald, Nikolai BogdukAbstract:SummaryPercutaneous radiofrequency neurotomy is a minimally invasive, neuroablative procedure used to interrupt nociceptive pathways in patients with intractable pain. In the context of chronic cervical Zygapophysial Joint pain, the target nerves are the medial branches of the cervical dorsal rami t
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CERVICAL SPINE DISORDERS
Current opinion in rheumatology, 1998Co-Authors: Nikolai Bogduk, Susan M. LordAbstract:Recent research of disorders of the neck has concentrated on the efficacy of manual and other conservative therapies for neck pain and whiplash. Systematic reviews paint a poor picture of the quality of literature upon which many conventional, conservative therapies are based. Conclusive scientific data are lacking. Despite its unsavory reputation, whiplash has attracted considerable scientific inquiry. Multiple studies have brought data to bear that indicate that chronic neck pain after whiplash is not psychogenic, and that psychologic distress is secondary to the pain. Strong studies have shown that cervical Zygapophysial Joint pain is the most common basis for chronic neck pain after whiplash but that this condition cannot be diagnosed other than by using controlled diagnostic blocks. Surgical treatment of cervical Zygapophysial Joint pain has been proven to be effective in a double-blind controlled trial.
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Chronic cervical Zygapophysial Joint pain after whiplash. A placebo-controlled prevalence study.
Spine, 1996Co-Authors: Susan M. Lord, Leslie Barnsley, Barbara J. Wallis, Nikolai BogdukAbstract:Study Design. The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. Ojective. To determine the prevalence of cervical Zygapophysial Joint pain among patients with chronic neck pain (more than 3 months's duration) after whiplash injury. Summary of Background Data. The prevalence of cervical Zygapophysial Joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. Methods. Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 Zygapophysial Joint. Patients who had positive responses concluded investigations. Those who did no experience pain relied together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive dignosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but no by the placebo injection. Results. Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 Zygapophysial Joint pain was 50%. Among those without C2-C3 Zygapophysial Joint pain, placebo-controlled blocks revealed the prevalence of lower cervical Zygapophysial Joint pain to be 49%. Overall, the prevalence of cervical Zygapophysial Joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%). Conclusion. Cervical Zygapophysial Joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be a major clinical importance.
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Percutaneous radiofrequency neurotomy in the treatment of cervical Zygapophysial Joint pain: a caution.
Neurosurgery, 1995Co-Authors: Susan M. Lord, Leslie Barnsley, Nikolai BogdukAbstract:Percutaneous radiofrequency neurotomy has been used in the treatment of pain from the cervical Zygapophysial Joints, but the results have been modest and not compelling. Several factors might account for its apparent poor success rate, including inadequate patient selection, inaccurate surgical anatomy, and technical errors. In an effort to overcome these confounders, we used comparative local anesthetic blocks to preoperatively, definitively diagnose cervical Zygapophysial Joint pain and developed an amended operative technique based on formal anatomical studies. An audit was conducted of our experience with 19 patients to determine whether there was sufficient merit in the amended procedure to justify a randomized, double-blind, controlled trial. The duration of complete pain relief was the principal outcome measure. Side effects and complications were also monitored. Of the 10 patients who underwent third occipital neurotomy for the treatment of C2-C3 Zygapophysial Joint pain, only 4 obtained long-lasting relief. The other six patients reported an early return of their pain and constituted technical failures; the third occipital nerve was inadequately coagulated and recovered in the immediate postoperative period. Of the 10 patients who underwent lower cervical medial branch neurotomy, 7 obtained complete pain relief for clinically useful periods and were able to resume their activities of daily living and employment. After procedures at all levels, a brief period of postoperative pain was experienced by the patients and ataxia was a side effect of third occipital neurotomy. There were no cases of postoperative infection or anesthesia dolorosa. Given the high technical failure rate of third occipital neurotomy, we recommend that this procedure be abandoned until the technical problems can be overcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Paul Dreyfuss - One of the best experts on this subject based on the ideXlab platform.
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the ability of lumbar medial branch blocks to anesthetize the Zygapophysial Joint a physiologic challenge
Spine, 1998Co-Authors: Michael Kaplan, Paul Dreyfuss, Bobby Halbrook, Nikolai BogdukAbstract:STUDY DESIGN Randomized, controlled, single blinded study. OBJECTIVES To determine the physiologic effectiveness of lumbar medial branch blocks. SUMMARY OF BACKGROUND DATA Zygapophysial Joint pain can be diagnosed by anesthetization of the Joint or its nerve supply (the medial branch divisions of the dorsal rami). The physiologic effectiveness of lumbar medial branch blocks has been assumed but not proven. METHODS Eighteen asymptomatic individuals were randomly assigned to either L4-L5 or L5-S1 Zygapophysial Joint injections with contrast medium until capsular distention elicited pain without extracapsular contrast spread. One week later, 15 blinded individuals underwent two randomized saline or 2% lidocaine medial branch injections that correlated to the innervation of the previously injected Joint. Medical branch injections were performed such that inadvertent venous uptake was avoided in 14 individuals. Thirty minutes after medial branch injections, these 14 individuals underwent repeat capsular distention of the same Zygapophysial Joint provoked the prior week in an attempt to elicit another painful response. RESULTS All five control individuals who received saline medial branch injections felt pain on repeat capsular distention. Nine individuals received 2% lidocaine medial branch blocks; eight felt no pain, and one felt pain on repeat capsular distention. CONCLUSIONS There was a significant effect of 2% lidocaine (versus saline) medial branch injections on anesthetization of the Zygapophysial Joint when venous uptake was avoided during these injections. When properly performed, lumbar medial branch blocks successfully inhibit pain associated with capsular distention of the lumbar Zygapophysial Joints at a rate of 89%.
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The ability of lumbar medial branch blocks to anesthetize the Zygapophysial Joint. A physiologic challenge.
Spine, 1998Co-Authors: Michael Kaplan, Paul Dreyfuss, Bobby Halbrook, Nikolai BogdukAbstract:Randomized, controlled, single blinded study. To determine the physiologic effectiveness of lumbar medial branch blocks. Zygapophysial Joint pain can be diagnosed by anesthetization of the Joint or its nerve supply (the medial branch divisions of the dorsal rami). The physiologic effectiveness of lumbar medial branch blocks has been assumed but not proven. Eighteen asymptomatic individuals were randomly assigned to either L4-L5 or L5-S1 Zygapophysial Joint injections with contrast medium until capsular distention elicited pain without extracapsular contrast spread. One week later, 15 blinded individuals underwent two randomized saline or 2% lidocaine medial branch injections that correlated to the innervation of the previously injected Joint. Medical branch injections were performed such that inadvertent venous uptake was avoided in 14 individuals. Thirty minutes after medial branch injections, these 14 individuals underwent repeat capsular distention of the same Zygapophysial Joint provoked the prior week in an attempt to elicit another painful response. All five control individuals who received saline medial branch injections felt pain on repeat capsular distention. Nine individuals received 2% lidocaine medial branch blocks; eight felt no pain, and one felt pain on repeat capsular distention. There was a significant effect of 2% lidocaine (versus saline) medial branch injections on anesthetization of the Zygapophysial Joint when venous uptake was avoided during these injections. When properly performed, lumbar medial branch blocks successfully inhibit pain associated with capsular distention of the lumbar Zygapophysial Joints at a rate of 89%.
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Low back pain and the Zygapophysial (facet) Joints
Archives of physical medicine and rehabilitation, 1996Co-Authors: Susan J. Dreyer, Paul DreyfussAbstract:A basic science and clinical review of low back pain due to the lumbar Zygapophysial (facet) Joints was performed based on a literature search of scientific journals and textbooks. Recent studies estimate that 15% to 40% of chronic low back pain is due to the Zygapophysial Joints. The histological basis for Zygapophysial Joint pain has been scientifically established, but the precise clinical etiology remains undetermined. There are no unique identifying features in the history, physical examination, and radiological imaging of patients with pain of lumbar Zygapophysial Joint origin. Spine physicians diagnose Zygapophysial Joint pain based on analgesic response to anesthetic injections into the Zygapophysial Joints or at their nerve supply. Studies on treatment of isolated Zygapophysial Joint pain are limited. This review summarizes current understanding of lumbar Zygapophysial Joint disorders while highlighting the need for additional research.
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Lumbar Zygapophysial (facet) Joint injections.
Spine, 1995Co-Authors: Paul Dreyfuss, Susan J. Dreyer, Stanley A. HerringAbstract:The lumbar Zygapophysial Joints are a potential cause of back and lower extremity pain. Absolute diagnosis of lumbar Zygapophysial Joint-mediated pain is based on selective analgesic injections of these Joints or their nerve supply. The therapeutic role of Zygapophysial Joint injections is controversial. This contemporary concepts paper reviews the anatomy, mechanics, pathology, and diagnosis of this condition. A critical review of previous studies assessing the role of diagnostic and potentially therapeutic Zygapophysial Joint injection procedures is presented. The need for future studies is addressed, and current recommendations for the role of Zygapophysial Joint injection procedures based on this critical scientific review are provided.
Andreas Siegenthaler - One of the best experts on this subject based on the ideXlab platform.
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spine section original research article a shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
2016Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Objective. Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60–70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2–4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method. Interventions. We prospectively studied 15 consecutive patients with diagnosed cervical Zygapophysial Joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the Joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment. Results. Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80–100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70–100%) and 6 patients (40%, 95% CI 15–65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes. Conclusion. In patients with cervical Zygapophysial Joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique.
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Accuracy of ultrasound-guided nerve blocks of the cervical Zygapophysial Joints.
Anesthesiology, 2012Co-Authors: Andreas Siegenthaler, Michele Curatolo, Sabine Mlekusch, Sven Trelle, Juerg Schliessbach, Urs EichenbergerAbstract:Cervical Zygapophysial Joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical Zygapophysial Joints using fluoroscopy as control.
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a shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
Pain Medicine, 2011Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60-70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2-4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method.
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A shortened radiofrequency denervation method for cervical Zygapophysial Joint pain based on ultrasound localization of the nerves
Pain medicine (Malden Mass.), 2011Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Michele CuratoloAbstract:Radiofrequency neurotomy is a recognized treatment for cervical Zygapophysial Joint pain. In several studies, the method has provided complete pain relief in 60-70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2-4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method. We prospectively studied 15 consecutive patients with diagnosed cervical Zygapophysial Joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the Joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment. Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80-100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70-100%) and 6 patients (40%, 95% CI 15-65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes. In patients with cervical Zygapophysial Joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique. Wiley Periodicals, Inc.
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What does local tenderness say about the origin of pain? An investigation of cervical Zygapophysial Joint pain.
Anesthesia and analgesia, 2010Co-Authors: Andreas Siegenthaler, Urs Eichenberger, Kurt Schmidlin, Lars Arendt-nielsen, Michele CuratoloAbstract:BACKGROUND: Mechanical pain sensitivity is assessed in every patient with pain, either by palpation or by quantitative pressure algometry. Despite widespread use, no studies have formally addressed the usefulness of this practice for the identification of the source of pain. We tested the hypothesis that assessing mechanical pain sensitivity distinguishes damaged from healthy cervical Zygapophysial (facet) Joints. METHODS: Thirty-three patients with chronic unilateral neck pain were studied. Pressure pain thresholds (PPTs) were assessed bilaterally at all cervical Zygapophysial Joints. The diagnosis of Zygapophysial Joint pain was made by selective nerve blocks. Primary analysis was the comparison of the PPT between symptomatic and contralateral asymptomatic Joints. The secondary end points were as follows: differences in PPT between affected and asymptomatic Joints of the same side of patients with Zygapophysial Joint pain; differences in PPT at the painful side between patients with and without Zygapophysial Joint pain; and sensitivity and specificity of PPT for 2 different cutoffs (difference in PPT between affected and contralateral side by 1 and 30 kPa, meaning that the test was considered positive if the difference in PPT between painful and contralateral side was negative by at least 1 and 30 kPa, respectively). The PPT of patients was also compared with the PPT of 12 pain-free subjects. RESULTS: Zygapophysial Joint pain was present in 14 patients. In these cases, the difference in mean PPT between affected and contralateral side (primary analysis) was −6.2 kPa (95% confidence interval: −19.5 to 7.2, P = 0.34). In addition, the secondary analyses yielded no statistically significant differences. For the cutoff of 1 kPa, sensitivity and specificity of PPT were 67% and 16%, respectively, resulting in a positive likelihood ratio of 0.79 and a diagnostic confidence of 38%. When the cutoff of 30 kPa was considered, the sensitivity decreased to only 13%, whereas the specificity increased to 95%, resulting in a positive likelihood ratio of 2.53 and a diagnostic confidence of 67%. The PPT was significantly lower in patients than in pain-free subjects (P < 0.001). CONCLUSIONS: Assessing mechanical pain sensitivity is not diagnostic for cervical Zygapophysial Joint pain. The finding should stimulate further research into a diagnostic tool that is widely used in the clinical examination of patients with pain.
