MRI Analysis of the Lumbar Spine: Can It Predict Response to Diagnostic and Therapeutic Facet Procedures?

Stojanovic, M.; Sethee, Jai; Mohiuddin, Meraj M.; Cheng, Jianguo; Barker, Amanda; Wang, Jing; Palmer, William E.; Huang, Jeffrey; Cohen, Steven P.

doi:10.1097/ajp.0b013e3181b8cd4d

Cited by 43 publications

(56 citation statements)

References 37 publications

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“…Although the literature suggests that facet interventions for LSS may have limited utility, 1 recent study suggested that radiofrequency (RF) ablation may have utility in treating pain in patients with radiographic evidence of central and lateral spinal stenosis . In this study of 127 subjects, preselected by a radiologist with musculoskeletal expertise and having confirmed evidence of central and lateral stenosis, there was a positive correlation of treatment success with RF ablation, but interestingly not with lumbar medial branch blocks.…”

Section: Therapies To Consider For the Treatment Algorithmmentioning

confidence: 99%

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Deer¹,

Grider

Pope

et al. 2018

Pain Practice

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Background Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. Methods The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer‐reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. Results The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image‐guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. Conclusions MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer‐reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence‐based decision algorithm.

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Section: Therapies To Consider For the Treatment Algorithmmentioning

confidence: 99%

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Deer¹,

Grider

Pope

et al. 2018

Pain Practice

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“…However none showed significant relationship in predicting positive response to medial branch block [2,23]. Facet joint disease findings from MRI images were interpreted differently among radiologists, which indicates a low reliability [7].…”

Section: Discussionmentioning

confidence: 99%

Value of Bone Scintigraphy and Single Photon Emission Computed Tomography (SPECT) in Lumbar Facet Disease and Prediction of Short-term Outcome of Ultrasound Guided Medial Branch Block with Bone SPECT

et al. 2011

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BackgroundFacet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block.MethodsSPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results.ResultsOf the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen.ConclusionsSPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.

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“…[6][7][8] These conflicting findings suggest a strong need to better identify treatment responders. [9][10][11][12][13] The use of "control" injections is frequently advocated to improve RF treatment outcomes, the rationale being that uncontrolled medial branch (facet joint nerve) blocks (MBBs) are associated with a high false-positive rate. 14,15 Numerous researchers and organizations have recommended the use of controlled injections as a means to reduce the high false-positive rate of diagnostic MBB and to improve treatment results.…”

Section: Methods: a Multicenter Prospective Study Was Performed In 223mentioning

confidence: 99%

Can Changes in Vital Signs Be Used to Predict the Response to Lumbar Facet Blocks and Radiofrequency Denervation? A Prospective, Correlational Study

Cohen¹,

Atanelov²,

Rammasubu

et al. 2014

Regional Anesthesia and Pain Medicine

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Although a decrease in DBP of more than 7.5 mm Hg had 97.3% specificity and 85.7% positive predictive value for predicting positive RF ablation outcomes, the low negative predictive value (56.3%) precludes its use as a solitary screening tool. An algorithm based on age, baseline NRS pain score, and a significant decrease in DBP was able to predict 76.7% (range, 65.8%-86.3%) of RF denervation outcomes.

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MRI Analysis of the Lumbar Spine: Can It Predict Response to Diagnostic and Therapeutic Facet Procedures?

Cited by 43 publications

References 37 publications

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Value of Bone Scintigraphy and Single Photon Emission Computed Tomography (SPECT) in Lumbar Facet Disease and Prediction of Short-term Outcome of Ultrasound Guided Medial Branch Block with Bone SPECT

Can Changes in Vital Signs Be Used to Predict the Response to Lumbar Facet Blocks and Radiofrequency Denervation? A Prospective, Correlational Study

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