scholarly journals Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

2012 ◽  
pp. 227 ◽  
Author(s):  
Laxmaiah Manchikanti ◽  
Cash ◽  
Pampati ◽  
Malla
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Joint Pain ◽  
Facet Joint ◽  
Epidural Injections ◽  
Facet Joint Pain

scholarly journals Do Cervical Epidural Injections Provide LongTerm Relief in Neck and Upper Extremity Pain? A Systematic Review

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. 39-60 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Upper Extremity ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Joint Pain ◽  
Facet Joint ◽  
High Quality ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Post Surgery ◽  
Facet Joint Pain

Background: The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. Objectives: To determine the long-term efficacy of cervical interlaminar and transforaminal epidural injections in the treatment of cervical disc herniation, spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. Methods: The literature search was performed from 1966 to October 2014 utilizing data from PubMed, Cochrane Library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references. The evidence was assessed based on best evidence synthesis with Level I to Level V. Results: There were 7 manuscripts meeting inclusion criteria. Of these, 4 assessed the role of interlaminar epidural injections for managing disc herniation or radiculitis, and 3 assessed these injections for managing central spinal stenosis, discogenic pain without facet joint pain, and post surgery syndrome. There were 4 high quality manuscripts. A qualitative synthesis of evidence showed there is Level II evidence for each etiology category. The evidence is based on one relevant, high quality trial supporting the efficacy of cervical interlaminar epidural injections for each particular etiology. There were no randomized trials available assessing the efficacy of cervical transforaminal epidural injections. Limitations: Paucity of available literature, specifically conditions other than disc herniation. Conclusion: This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome. Key words: Chronic neck pain, cervical disc herniation, cervical spinal stenosis, cervical post surgery syndrome, cervical discogenic pain, cervical epidural injections, interlaminar epidural injections, transforaminal epidural injections, steroids, local anesthetic

scholarly journals Cervical Epidural Injections in Chronic Discogenic Neck Pain Without Disc Herniation or Radiculitis: Preliminary Results of a Randomized, Double-Blind, Controlled Trial

2010 ◽  
Vol 4;13 (4;7) ◽  
pp. E265-E278
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Chronic Neck Pain ◽  
Double Blind ◽  
Epidural Injections ◽  
Group I ◽  
Group Ii ◽  
Facet Joint Pain

Background: Chronic neck pain is a common problem in the adult population with a typical 12- month prevalence of 30% to 50%. However, there is a lack of consensus regarding the causes and treatments of chronic neck pain. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Study Design: A randomized, double-blind, active control trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections with local anesthetic with or without steroids in the management of chronic neck pain with or without upper extremity pain in patients without disc herniation or radiculitis or facet joint pain. Methods: Patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of 2 groups: injection of local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Seventy patients were included in this analysis. Randomization was performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief or functional status was defined as a 50% or more reduction. Results: Significant pain relief (≥ 50%) was demonstrated in 80% of patients in both groups and functional status improvement (> 50%) in 69% of Group I and 80% of Group II. The overall average procedures per year were 3.9 ± 1.01 in Group I and 3.9 ± 0.8 in Group II with an average total relief per year of 40.3 ± 14.1 weeks in Group I and 42.1 ± 9.9 weeks in Group II over a period of 52 weeks in the successful group. Limitations: The results of this study are limited by the lack of a placebo group and that it is a preliminary report of 70 patients, with 35 patients in each group. Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic. Key words: Chronic neck pain, cervical disc herniation, cervical discogenic pain, cervical epidural injections, epidural steroids, local anesthetics

scholarly journals An Updated Review of the Diagnostic Utility of Cervical Facet Joint Injections

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E807-E838
Author(s):  
Sukdeb Datta
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Diagnostic Accuracy ◽  
Joint Pain ◽  
Facet Joint ◽  
Chronic Neck Pain ◽  
Nerve Blocks ◽  
Facet Joint Pain ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Chronic persistent neck pain with or without upper extremity pain is common in the general adult population with a prevalence of 48% for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple modalities of treatment are exploding in managing chronic neck pain along with increasing prevalence. However, there is a paucity of evidence for all modalities of treatments in managing chronic neck pain. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 60% in heterogenous population of these patients. However, these studies also have shown false-positive results in 27% to 63% of patients with a single diagnostic block. Study Design: A systematic review of diagnostic cervical facet joint nerve blocks. Objective: To evaluate and update the accuracy of diagnostic facet joint nerve blocks in the diagnosis of facet joint pain. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and critically analyzed. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Results: Overall, a total of 26 manuscripts were considered for diagnostic accuracy evaluation and 9 manuscripts for studies evaluating various factors influencing the diagnostic validity of facet joint interventions. Based on 9 studies meeting the inclusion criteria utilizing 75% to 100% pain relief as the criterion standard with controlled blocks, the evidence is good for diagnostic accuracy of cervical facet joint pain, with a prevalence of 36% to 60% with a false-positive rate of 27% to 63% with a single block. Based on 2 studies from the same group of authors, the evidence for 75% to 100% pain relief as the criterion standard with a single block is limited. The evidence is limited for a single diagnostic block with 50% to 74% pain relief as the criterion standard, whereas no studies were available assessing the accuracy of 50% to 74% pain relief as the criterion standard with controlled blocks. Limitations: The limitations of this systematic review include a paucity of literature on outcomes, randomized, placebo-controlled trials and a lack of consensus on a gold standard. Conclusions: Diagnostic cervical facet joint nerve blocks are safe, valid, and reliable. The strength of evidence for diagnostic facet joint nerve blocks is good with the utilization of controlled diagnostic blocks with at least 75% pain relief as the criterion standard; however, the evidence is limited for single blocks or dual blocks for relief of 50% to 74% and single blocks with at least 75% pain relief. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medial branch blocks, controlled comparative local anesthetic blocks

Fear-Avoidance Beliefs in Chronic Cervical Zygapophyseal Joint Pain Relieve With Medial Branch Block

2018 ◽  
Vol 1 (2) ◽  
pp. 12
Author(s):  
Farid Yudoyono
Keyword(s):  
Neck Pain ◽  
Physical Examination ◽  
Neurological Deficit ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Zygapophyseal Joint ◽  
Fear Avoidance ◽  
Posterior Neck ◽  
Facet Joint Pain

Background: Chronic posterior neck pain is common, affecting 50–75% of people for 1 year or longer. The zygapophyseal joint is reported to be one of most common causative factors. The fear-avoidance is a model that describes how individuals develop chronic pain as a result of avoidant behaviour based on fear. Previous studies shown that medial branch block (MBB) and radio frequency neurotomy were effective for intractable pain.Material And Method: Case 1, TMK, Male, 57 yo, left posterior neck pain, VAS neck 7-8, NDI 46 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 2, RDW, Male, 45 yo, left posterior neck pain, VAS neck 8-9, NDI 40 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (63%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 3, TAY, Female, 52 yo, bilateral posterior neck pain, VAS neck  8-9, NDI 52 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI.Results: Our study reveals that C-MBB might ensure pain relief and decrease analgesic need. Physical activity at 1-, 3- and 6-months post-CMBB intervention were 65%, 60% and 68% of patients, respectively, gained >50% pain relief.Conclusion: Therapeutic MBB may provide an option for chronic high fear-avoidance beliefs pain of zygapophyseal joint.

Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain

Spine ◽  
2018 ◽  
Vol 43 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Dong Gyu Lee ◽  
Sang Ho Ahn ◽  
Yun Woo Cho ◽  
Kyung Hee Do ◽  
Sang Gyu Kwak ◽  
...  
Keyword(s):  
Joint Pain ◽  
Facet Joint ◽  
Steroid Injection ◽  
Medial Branch ◽  
Medial Branch Block ◽  
Facet Joint Pain

The response to radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints

2018 ◽  
Vol 18 (4) ◽  
pp. 747-753
Author(s):  
Olav Rohof ◽  
Chee Kean Chen
Keyword(s):  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Controlled Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Medial Branch ◽  
Pain Disability Index ◽  
The Mean ◽  
Facet Joint Pain

AbstractBackground and aimsThe evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain.MethodsThis is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015. The outcome measures were mean changes in Numeral Rating Scale (NRS) and Pain Disability Index (PDI).ResultsThere were 71 patients with complete data available for analysis. The mean age of the patients was 57.9±11.2 years. The mean duration of pain was 23±10.5 months. The majority of patients (82%) had pain reduction of more than 50% at 12 months after bipolar RF neurotomy. The NRS decreased significantly from baseline of 7.75±1.25 to 2.86±1.53 at 3 months and 2.82±1.29 at 12 months post-procedure (p<0.001.p<0.001, respectively). The PDI improved significantly from 40.92±12.22 to 24.15±9.79,p<0.05). There were no serious adverse effects or complications of the procedure reported in this study.ConclusionsBipolar RF neurotomy of thoracic medial branch is associated with a significant reduction in thoracic facet joint pain. The promising findings from this case series merit further assessment with prospective, randomized controlled trial which will produce a more reliable and accurate finding for its clinical applications.

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