Predictors of Response to a Medial Branch Block: MRI Analysis of the Lumbar Spine

Abstract

The aim of this study was to determine the association between radiologic spinal pathology and the response to medial branches block (MBB). This retrospective observational study compared 165 patients. A successful response was defined as ≥30% or a 2-point reduction in the numeric rating scale (NRS) compared with the baseline at the 1-month follow-up. The facet angle, facet angle difference, facet joint degeneration, disc height and spondylolisthesis grade were analyzed from an MRI at the L3 to S1 levels. Univariate and multivariate logistic regression analyses were used to evaluate independent factors associated with a successful response of MBB. In the univariate analysis, the disc height at L5–S1 and facet angle difference at L3–4 were lower in the positive responders (p = 0.022 and p = 0.087, respectively). In the multivariate analysis, the facet angle difference at L3–4 and disc height at L5–S1 were independent factors associated with a successful response (odds ratio = 0.948; p = 0.038 and odds ratio = 0.864; p = 0.038, respectively). In patients with a degenerative disc at L5–S1, MBB can lead to a good response for at least one month. In patients with facet tropism at L3–4 level, the response to MBB after one month is likely to be poor.

Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study

“…The predictor variables that were associated with achieving the SCB threshold at a significance level of p < 0.1 in the univariate analysis were entered into a multivariate logistic regression model, using a Backward Wald stepwise method. The threshold of p < 0.1 at the univariate stage was chosen to minimise the chance of eliminating potentially predictive variables at this stage [34]. Primary data analysis was conducted using logistic regression analysis and participants with a full data set (no missing outcome or predictor variables).…”

Evaluation of the Predictors for Unfavorable Clinical Outcomes of Degenerative Lumbar Spondylolisthesis After Lumbar Interbody Fusion Using Machine Learning

“…The structure, locating on the posterolateral region of the vertebral body and connecting the adjacent vertebral arch, is the facet joint, which constitutes the classic triple-joint complex with the intervertebral disc ( 28 ). In the current study, outcomes in consecutive patients suggested that increased FA limits functional recovery in the short term without impacting on long-term outcomes.…”

“…Assuming FA does not actually worsen surgical outcomes ( 31 ), a more convincing association was acknowledged. Due to the local fixation with pedicle screws, the altered facet joint stress accelerated disc degeneration, leading to an additional influence of disc height in predicting long-term outcomes ( 28 ). This explanation was also corroborated in this study.…”

“…The finite element analysis from Park et al externally verified the homogeneity between DH and FA ( 32 ). Moreover, in the current healthcare system, pain management has become an important part of surgical intervention, especially in the treatment of degenerative spinal diseases, and has shown promising results ( 28 , 33 – 35 ). Nevertheless, for postoperative patients, pain is a generalized clinical symptom.…”

The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

“…Although this scale has been used as a means of surgical planning by identifying specific levels of pathology and disease severity, validity studies have reported conflicting results at best [ 16 , 17 , 18 ]. One retrospective observational study by Park et al included 165 patients, and demonstrated an association between facet angle difference (facet tropism) at L3–4 and disc height at L5–S1 to positive medial branch block response; however, the study’s power is limited and, thus, requires further investigation [ 19 ].…”