Correlation of Lumbar Medial Branch Neurotomy Results with Diagnostic Medial Branch Block Cutoff Values to Optimize Therapeutic Outcome

Abstract

The double MBB protocol better correlated with favorable MBN outcomes compared with a single MBB protocol. Using a double MBB protocol, a 70% cutoff value for reported subjective pain relief post-MBB best predicted overall outcome following MBN. Without a confirmatory MBB, an 80% cutoff value was the optimal value.

Long-Term Function, Pain and Medication Use Outcomes of Radiofrequency Ablation for Lumbar Facet Syndrome

“…This study suggests that dual compared to single diagnostic MBBs may result in improved outcomes of RFA at long-term follow-up, however, further comprehensive research is needed as this remains a controversial clinical decision. Although dual comparative MBBs with responses of >75–80% have been recommended [ 33 , 37 , 38 ], others report that one set of blocks is sufficient to proceed with RFA [ 26 , 27 ], particularly in the context of reduced cost [ 24 , 25 ] and complication rates [ 5 ]. Additionally, some insurers will not pay for a second set of confirmatory MBBs, thus while dual MBBs decrease the chance of false positive diagnoses of lumbar facet syndrome, in a realistic busy clinical practice, the dual block paradigm may not be practical.…”

“…Additionally, to be included, individuals had to have experienced >75% reduction in back pain symptoms following one set of diagnostic medial branch blocks (MBBs), or >75% pain reduction following a second set of confirmatory MBBs. A single set of positive MBBs (>75% pain relief), as opposed to dual comparative MBBs, has been established as a pragmatic clinical cut-off due to reduced cost [ 24 , 25 ], decreased risk of serious complications (epidural abscess, epidural hematoma, meningitis, etc) [ 5 ], and an acceptable false-positive rate in this context [ 26 , 27 ]. A second set of confirmatory MBBs was performed if patients experienced >50% relief, but <75% relief as has been previously recommended given the possibility of false negatives with 1 set of MBBs [ 28 ].…”

Quality of Life in Patients after Lumbar Thermolesion

“…In patients with chronic pain there appears depression, which to a lesser degree seems to lower the mood but more often is associated with outbursts of anger and irritation. Outbursts of aggression in consequence cause the gradual elimination of all signs of social activity, the psychological isolation and closing in oneself [13][14][15].…”

Correlation of99mTc-DPD SPECT/CT Scan Findings and Diagnostic Blockades of Lumbar Medial Branches in Patients with Unspecific Low Back Pain in a Randomized-Controlled Trial

“…Several systematic assessments proposed a cut off value of 80% pain reduction. However, Derby et al recently proposed a cut off value of 70% pain reduction for double block protocols as the “best compromise between successful outcome and unfair denial of care.” The ability to perform previously painful movements additionally provides strong evidence in the diagnosis of zygapophyseal joint‐related pain .…”