Osteoarthritis of the spine: the facet joints

Gellhorn, Alfred; Katz, Jeffrey N.; Suri, Pradeep

doi:10.1038/nrrheum.2012.199

Cited by 395 publications

(357 citation statements)

References 95 publications

(136 reference statements)

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“…In our protocol, we treated four FJ per patient, at L 4 -L 5 and L 5 -S 1 level, which are those with the highest prevalence of OA alterations, even though MR examinations showed slight degenerative changes also at other lumbar levels [21,22].…”

Section: Techniquementioning

confidence: 99%

In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections

Sartoris

Orlandi²,

Corazza

et al. 2017

J Ultrasound

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Objectives Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation. Methods Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks.Results All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intraarticular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed. Conclusions Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.Keywords Facet joint Á Injection Á Fusion imaging Á Ultrasound Á Magnetic resonance Sommario Obiettivi Tradizionalmente, le iniezioni delle faccette articolari (FJI) sono state eseguite sotto guida fluoroscopica o tomografia computerizzata (TC), principalmente a causa della posizione anatomica profonda e la presenza di reperi ossei. L'imaging di fusione permette di accoppiare le immagine ecografiche con quelle TC o di risonanza magnetica (RM) corrispondenti, ottenute da un precedente esame diagnostico e riformattate in tempo reale in base al piano di scansione ecografico. Questa tecnica permette di coniugare la visione panoramica e l'elevato dettaglio anatomico della RM o TC con la praticità della guida ecografica senza ulteriore esposizione del paziente a radiazioni ionizzanti. Metodi Trentotto pazienti (24 femmine, età media ± DS: 64 ± 9 anni) hanno ricevuto FJI guidata da fusione ecografia-RM di 1 ml di una miscela di anestetico locale e corticosteroide utilizzando una apparecchiatura ecografica (Logiq E9, GE Healthcare) dotata di tecnologia fusion. Nei (2017( ) 20:23-31 DOI 10.1007 primi 28 pazienti il posizionamento dell'ago è stato confermato mediante esame TC a bassa dose. Il dolore dei pazienti è stato registrato utilizzando una scala analogica visiva (VAS), al tempo 0 e dopo 2, 4 e 8 settimane.Risultati Tutte le iniezioni fusion guidate sono state esegui...

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Section: Techniquementioning

confidence: 99%

In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections

Sartoris

Orlandi²,

Corazza

et al. 2017

J Ultrasound

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“…According to this report, no form of imaging has proved to be capable of identifying painful facets. The recent study indicates that there is no validated diagnostic test to identify painful facet joints 6) . The label "lumbar degenerative disc disease (DDD)" has also been criticized.…”

Section: Criticism On Diagnostic Labelmentioning

confidence: 99%

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Kikuchi

2017

Spine Surg Relat Res

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Abstract:Introduction: Development of evidence-based medicine has made a big change in diagnosis and treatment of chronic low back pain. The recent trend is assessed through a review of literature. Methods: The articles published in these 10 years are reviewed, and important points are examined. Results: In diagnosis, challenges for history taking and limit of imaging or clinical guidelines are revealed. In treatment, cognitive behavioral treatment and exercises are proved effective. Sleep disturbance has recently attracted attention as a factor associated with low back pain. Cost-effectiveness of diagnosis and treatment modalities has come to be emphasized. Conclusions: Diagnosis and treatment of chronic low back pain have been significantly changing. Multidisciplinary and multidimensional approach is essential. Chronic low back pain should be treated as a total pain, not a local pain.

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“…However, with respect to the recent literature and to our own experience, we recommend the inclusion of fluid-sensitive MRI sequences (such as Short-Tau Inversion Recovery [STIR] sequences) in patients with known or suspected LSS to detect unexpected subtle fractures, tumor involvement or Modic 1 end-plate changes of the lumbar spine. [25][26][27] Furthermore, MRI scans were performed in supine position which is currently standard of care. In addition, we did not investigate into the inter-reader reliability of the MRI image analysis.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis?

Burgstaller

Schüffler

Buhmann

et al. 2016

Spine

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(2016). Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis? Spine, 41(17) : AbstractStudy design: Prospective multi-center cohort study.Objective: To identify an association between pain and magnetic resonance imaging (MRI) parameters in patients with lumbar spinal stenosis (LSS). Summary of Background Data:To the present, the relationship between abnormal MRI findings and pain in patients with LSS is still unclear.Methods: First we conducted a systematic literature search. We identified relationships of relevant MRI parameters and pain in patients with LSS. Second, we addressed the study question with a thorough descriptive and graphical analysis to establish a relationship between MRI parameters and pain using data of the lumbar spinal stenosis outcome study (LSOS).Results: In the systematic review including four papers about the associations between radiological findings in the MRI and pain, the authors of two articles reported no association and two of them did. Of the latters, only one study found a moderate correlation between leg pain measured by Visual Analogue Scale (VAS) and the degree of stenosis assessed by spine surgeons. In the data of the LSOS study we could not identify a relevant association between any of the MRI parameters and buttock, leg and back pain, quantified by the Spinal Stenosis Measure (SSM) and the Numeric Rating Scale (NRS). Even by restricting the analysis to the level of the lumbar spine with the most prominent radiological 'stenosis' no relevant association could be shown. Conclusion:Despite a thorough analysis of the data we were not able to prove any correlation between radiological findings (MRI) and the severity of pain. There is a need for innovative 'methods/techniques' to learn more about the causal relationship between radiological findings and the patients' pain related complaints.

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Osteoarthritis of the spine: the facet joints

Cited by 395 publications

References 95 publications

In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections

In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis?

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