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Level IV. Retrospective study.

Background: Facet joint blockage is a type of regional anesthesia which is performed selectively on the medial branch of the ramus dorsalis of the spinal nerve and is a current approach for the treatment of pain originating from facet arthropathy. This current approach to chronic low back pain caused by facet joint pathology is usually performed with ultrasound guidance. Objectives: The accuracy of anatomical placement of the facet joint with ultrasonography guidance is determined by C-arm fluoroscopy image taken as reference. Patients and Methods: A total of 22 patients who were diagnosed with facet joint syndrome were involved in the study. After detecting the superolateral corner of the facet joint, which is the target point with ultrasound, the control was provided with C-arm fluoroscopy by giving radiopaque fluid. In order to verify the localization, a mixture of 40 mg triamcinolone and 1 cc 2% lidocaine was injected. Results: Nerve blockage was applied to 67 facet joints at L3-L4, L4-L5 and L5-S1 level in a total of 22 patients (15 female and seven male) diagnosed with facet joint syndrome. The patients' mean age was 63 (range, 48-80), the mean body mass index was 28.4 (range, 18.9-38.1) and the mean time to determine facet localization with ultrasonography (USG) was 240 seconds (range, 140-320). Patients' mean visual analog scale (VAS) decreased from 7 (range, 6-9) to 2.5 (range, 1-6). In the C-arm fluoroscopy control after the injection of radio-opaque material, the needle was found to be located in the lamina in four segments and it was relocated. In addition to this, two facet joints were not localized in ultrasound. This study concluded that the location of the facet joint with USG guidance is possible with 91% sensitivity and 100% positive predictive value when C-arm fluoroscopy was regarded as a gold standard in determining facet joint localization. No complications were observed. Conclusion: The results showed that ultrasonography guided facet joint block can be considered as a minimally invasive procedure that could be easily applied without radiation exposure.

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Objective To evaluate and compare peri-operative technical difficulties associated with single-level transforaminal lumbar interbody fusion (TLIF) and peri-operative outcomes between obese and non-obese patients. Subjects and methods The data, including age, blood transfusion volume, preoperative hemoglobin/hematocrit levels, operative time, blood loss, fluoroscopy time, skin incision length, and body mass index (BMI), of 53 patients undergoing single-level TLIF (L4–5 or L5–S1) between 2016 and 2018 were analyzed retrospectively. The patients were divided into two groups: BMI < 30 kg/m 2 and BMI 30–39.9 kg/m 2 . Parameters were subjected to statistical analysis according to the BMI. Results There were 26 patients in the BMI < 30 kg/m 2 group and 27 patients in the BMI 30–39.9 kg/m 2 group. The average age of the patients was 60.8 years (30–70 years), and the average BMI was 29.9 kg/m 2 (23.1–39.9 kg/m 2 ). The fluoroscopy times and skin incision lengths were significantly different between the two groups (p < 0.05). Conclusions An experienced surgical team can safely apply the TLIF procedure in patients with obesity but it should be taken into consideration by surgeons before surgery. Some modifications in the surgical technique, including, further lateral dissection and wider skin incision in the TLIF technique for obese patients may be required during the procedure. This approach makes TLIF technique easier and safer in obese patients. The longer fluoroscopy times in obese patients indicate that more radiation exposure occurs during TLIF and that necessary precautions should be taken for maintaining surgical team and patient health.