Abstract
Facetogenic back pain results from involvement of spinal zygapophyseal or facet joints. The common symptoms are diffuse back pain, localized tenderness at facet joints, reduced functionality. Lumbar radiculopathy due to facet hypertrophy is also a well known neurological condition. Facet arthropathy can be diagnosed clinically by local tenderness and quadrant loading test and by MRI with evidence of facet hypertrophy while the best known clinical test for lumbar radiculopathy is straight leg raising (SLR) test.
Nerve block with steroid and local aneasthetic at Medial Branch of dorsal rami, which supplies facet joint is a very common minimally invasive procedure in the treatment of facet arthropathy. The aim of our study was to observe the efficacy of Medial Branch Block (MBB) in the treatment of low back pain (LBP) with radiation associated with facet hypertrophy.
Twenty nine patients, included in the study as per inclusion criteria, were treated with MBB apart from getting other conventional pharmacological and non pharmacological conservative managements. They were assessed on the day of intervention and at two weeks follow up, for the parameters of back pain, facet joint tenderness, SLR and activity.
Finally twenty four patients completed the study and the resultant data was analysed with appropriate statistical tools. All the parameters had shown statistically significant improvement over follow up. SLR on the ipsilateral side has shown better improvement than contralateral side. This short term study indicates towards the efficacy of MBB in controlling both LBP and radiating pain in patients suffering from facet hypertrophy.
Keywords: Facet Hypertrophy, Zygapophyseal Joint, Medial Branch Block, Low Back Pain, Facet Joint Intervention.
References
- Morris JM. Biomechanics of the lumbar spine. In: Low back pain. Finnison BE. ed. Philadelphia: Lippincotf, 1980; 27-43.
- Mooney V. Robertson J. The facet syndrome. Clin Orthop 1976; 115:149-156.
- Carrera GF. Computed tomography of the lumbar facet joints. In: Computed tomography of the spine. Donavan Post MJ, ed. Baltimore: Williams & Wilkins, 1984; 485-491.
- Lewin T. Osteoarthritis in lumbar synovial joints: A morphologic study. ACTA Orthop Scand 1964; 73(suppl.):1-111.
- Bogduk N: Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. The Spine Journal 2008; 8:56-64,
- Cohen SP, Raja SN: Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007; 106: 591-614,
- Dreyer SJ, Dreyfuss P. Low back pain and the zygapophysial (facet) joints. Arch Phys Med Rehabil 1996; 77:290-300,
- Stuber K, Lerede C, Kristmanson K, Sajko S, Bruno P. The diagnostic accuracy of the Kemp’s test: a systematic review. J Can Chiropr Assoc 2014; 58(3): 258-67.
- Carrino JA, Lurie JD, Tosteson ANA, Tosteson TD, Carragee EJ, Keiser J, Grove MR, Blood E, Pearson LH, Weinstein JN, Herzog R. Lumbar Spine: Reliability of MR Imaging Findings. Radiology 2009; 250(1): 161-170.
- Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013 April ; 9(4): 216–224
- Schellinger D, Wener L, Ragsdale BD, Patronas NJ. Facet joint disorders and their role in the production of back pain and sciatica. Radiographics 1987; 7(6): 923-44.
- Manchikanti L, Singh V, Falco FJA, Cash KM, Fellow B . Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up. J. Med. Sci. 2010, 7(3): 124-35.
- Manchikanti L, Singh V, Falco FJA, Cash KA, Pampati V. Cervical Medial Branch Blocks for Chronic Cervical Facet Joint Pain. A Randomized, Double-Blind, Controlled Trial With One-Year Follow-up. Spine 2008; 33(17): 1813–20.
- Rocha ID, Cristante AF, Marcon RM, Oliveira RP, Letaif OB, Filho T. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics 2014;69(8):529-534
- Ospina A, Campuzano D, Hincapie E, Vasquez LF, Montoya E, Zapata IC, Gomez M, Bareno J. Efficacy of facet block in lumbar facet joint syndrome patients. Rev Colomb Anestesiol. 2012;40(3):177–182.
- Lee HS, Park SB, Lee SH, Chung YS, Yang HJ, Son YJ . The Effect of Medial Branch Block for Low Back Pain in Elderly Patients. The Nerve 2015;1(1):15-19.
- Park KD, Jee H, Nam HS, Cho SK, Kim HS, Park Y, Lim OK . Effect of Medial Branch Block in Chronic Facet Joint Pain for Osteoporotic Compression Fracture: One Year Retrospective Study. Ann Rehabil Med 2013;37(2):191-201.
Corresponding Author
Dr Kshetra Madhab Das
Flat - 4N, Block - A, Sherwood Estate, 169 N S C Bose Road,
Kolkata, West Bengal, India, Pin-700103
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 9830790414