A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

Abstract

Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques.

Comparison of Percutaneous Endoscopic Lumbar Diskectomy and Open Lumbar Microdiskectomy for Recurrent Lumbar Disk Herniation

“…Back pain has various causes, and cytokine and inflammatory substances associated with disk ruptures are removed during the surgery, which may partially explain why improvements in postoperative back pain were observed in the two groups. 33,34 Epidural and perineural scar tissue often make repeated OLM more difficult and increase the risk of nerve root injuries that may cause clinical sequelae and poor clinical outcomes. 7,35 In previous studies, permanent foot drop and persistent voiding disturbances were reported, and there was one case of foot drop and seven cases of transient sensory change in the present study.…”

Mechanisms of low back pain: a guide for diagnosis and therapy

“…These joints have a large amount of free and encapsulated nerve endings 52 that activate nociceptive afferents and that are also modulated by sympathetic efferent fibers 53 . Lumbar zygapophyseal or “facet” joint pain has been estimated to account for up to 30% of CLBP cases 54 , with nociception originating in the synovial membrane, hyaline cartilage, bone, or fibrous capsule of the facet joint 55 .…”

Percutaneous Neurolysis with Continuous Radiofrequency Energy for the Treatment of Symptomatic Sacroiliac Joints: Study of Clinical Safety and Efficacy

“…Imaging guidance is a prerequisite for correct canula placement; fluoroscopy and ultrasound are the most commonly used modalities [8][9][10]. Cone beam fluoroscopy can provide CT like 3D reconstructions acting as a problem solver in obese patients or other difficult situations; alternatively navigation and reconstruction systems may also be used to facilitate multiplanar imaging of ultrasound-guided injections [11,12].…”