Low back pain (LBP) is the most common pain syndrome, and is an enormous burden and cost generator for society. Lumbar facet joints (FJ) constitute a common source of pain, accounting for 15–45% of LBP. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain. History and physical examination may suggest but not confirm facet joint syndrome. Although imaging (radiographs, MRI, CT, SPECT) for back pain syndrome is very commonly performed, there are no effective correlations between clinical symptoms and degenerative spinal changes. Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain. These patients may benefit from specific interventions to eliminate facet joint pain such as neurolysis, by radiofrequency or cryoablation. The purpose of this review is to describe the anatomy, epidemiology, clinical presentation, and radiologic findings of facet joint syndrome. Specific interventional facet joint management will also be described in detail.Teaching points
• Lumbar facet joints constitute a common source of pain accounting of 15–45%.
• Facet arthrosis is the most frequent form of facet pathology.
• There are no effective correlations between clinical symptoms, physical examination and degenerative spinal changes.
• Diagnostic positive facet joint block can indicate facet joints as the source of pain.
• After selection processing, patients may benefit from facet joint neurolysis, notably by radiofrequency or cryoablation.
Background: Pudendal neuralgia (PN) is a very painful and often disabling condition in which
pudendal nerve blocks play an important role in both the diagnosis and management of PN. Some
previous reports have advocated the use of pudendal nerve infiltration (PNI) as a diagnostic test
only.
Objective: We aim to assess the outcomes of patients with typical refractory PN who underwent
dual site computed tomography (CT)-guided pudendal nerve infiltration.
Study Design: A bicentric, retrospective cohort analysis.
Setting: An academic practice.
Methods: Between 2002 and 2016, 385 PNIs were performed in 195 patients in the 2 units.
Only patients suffering from typical clinical PN were included, and only the first infiltration in
each patient was considered for analysis. Therefore, 95 patients who underwent 155 procedures
were assessed. Pain was assessed using a visual analog scale (0–10) and self-reported estimated
improvement (SRI), expressed as a percentage. Efficacy of the procedure was assessed at 1, 3, and
6 months after procedure follow-up, and clinical success was defined as a 50% decrease of the
VAS score. All procedures were performed under CT guidance and on an outpatient basis. Dual
site infiltration was performed in each case at both the ischial spine and intra-Alcock’s canal sites
using a mixture of fast- and slow-acting anesthetic (1 mL lidocaine hydrochloride 1% and 2 mL
ropivacaine chlorhydrate) along with a half dose of 1.5 mL of cortivazol (3.75 mg).
Results: Clinical success at one month post-procedure was present in 63.2% of patients (60/95)
with a mean VAS score of 2.07 (P < 0.05) and a mean SRI of 71%. At 3 months follow-up, clinical
success was still present in 50.5% of patients (48/95) with a mean VAS score of 2.90/10 (P < 0.05)
and a mean SRI of 62.3%. At 6 months follow-up, the efficacy rate decreased to 25.2% with a
mean VAS score of 3.2/10 and SRI of 60%.
Limitations: The retrospective aspect of the study is a limitation, as well as the lack of a control
group.
Conclusion: Dual site PNI under CT guidance may offer significant mid-term pain relief to a
majority of patients suffering from typical refractory PN.
Key words: Pudendal nerve, neuralgia, block, Alcock, CT, guidance
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