Radiofrequency Neurotomy Does Not Cause Fatty Degeneration of the Lumbar Paraspinal Musculature in Patients with Chronic Lumbar Pain—A Retrospective 3D-Computer-Assisted MRI Analysis Using iSix Software

Oswald, Katharina A. C.; Ekengele, I Venant; Hoppe, I Sven; Streitberger, I Konrad; Harnik, Michael Alexander; Albers, I Christoph E

doi:10.1093/pm/pnac103

Cited by 9 publications

(3 citation statements)

References 33 publications

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“…[ 44 ], and a significant loss of paravertebral muscles, requiring stabilization, was observed after cervical MB radiofrequency denervation [ 45 ]. On the contrary, recently published articles did not confirm these findings [ 46 ]. This conflicting evidence seems related to the use of different methods to measure muscular atrophy and does not consider possible catabolic effects of injected steroids on muscle tissue [ 47 ].…”

Section: Discussionmentioning

confidence: 77%

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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Introduction A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. Methods An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Results Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3–5], number of diagnostic blocks (37%, median 4, IQR 2–4), bilateral denervation (59%, median 4, IQR 2–4), technique and number of lesions (66%, median 4, IQR 3–5), and strategy after denervation failure (68%, median 4, IQR 3–4). Conclusion Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-023-00512-2.

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Section: Discussionmentioning

confidence: 77%

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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“…48 Recently, RFA has also been proven to preserve the surrounding muscles well. Oswald et al 57 retrospectively reviewed symptomatic facet joint pain patients treated with RFA. They used magnetic resonance imaging analysis to compare the lumbar paraspinal musculature before and at least 6 months after the surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Clinical Interventions for Sacroiliac Joint Pain: Systematic Review and Network Meta-analysis With Preliminary Design of Treatment Algorithm

Liu,

Suvithayasiri,

Kim

2023

Neurospine

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Objective: We aimed to identify the most effective clinical treatment method for sacroiliac joint (SIJ)-related pain based on the systematic review and network meta-analysis (NMA) to evaluate the comparative efficacy of clinical interventions for sacroiliac joint pain by pooling the randomized controlled trials (RCTs).Methods: Our team conducted a systematic review and NMA of RCTs to determine the most effective clinical treatment for SIJ-related pain. We searched the PubMed (MEDLINE), Web of Science, Cochrane Library, and Scopus databases for RCTs until February 2023. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were followed. Pairwise and network meta-analyses were conducted using a random effects model.Results: Based on the search strategy and inclusion criteria, our systematic review and NMA included 9 randomized studies with 652 participants. Research has mainly focused on various radiofrequency sources, but their number is still low. In the network analysis, according to the NMA and mean ranking probabilities for the improvement of pain intensity (PI) and quality of life (QoL), sacroiliac joint fusion and cooled radiofrequency were associated with high treatment rank for improving PI and QoL in patients with sacroiliac joint pain.Conclusion: This NMA suggest that SIJ fusion and cooled radiofrequency could be potential options for improving the QoL and relieving pain in patients with SIJ-related pain. Comparison studies of outcomes between these 2 procedures with solid methodology and a low risk of bias would be very beneficial to identify the optimal treatment option for this challenging disease.

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“…16 Another retrospective study (n = 20) found no differences in the paraspinal intramuscular adipose tissue volume and distribution before and after RFN. 115 An analysis of aforementioned studies on behalf of the Spine Intervention Society Patient Safety Committee concluded that despite inconclusive evidence for multifidus atrophy after MBB radiofrequency, some degree of atrophy is plausible but requires further study. 116…”

Section: Com Pl Icat Ion Smentioning

confidence: 99%

3. Pain originating from the lumbar facet joints

Van den Heuvel,

Cohen,

de Andrès Ares

et al. 2023

Pain Practice

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IntroductionPain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well‐designed studies, the prevalence is generally between 10% and 20%, increasing with age.MethodsThe literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.ResultsThere are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni‐ or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non‐dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After “red flags” are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.ConclusionsWell‐selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

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Radiofrequency Neurotomy Does Not Cause Fatty Degeneration of the Lumbar Paraspinal Musculature in Patients with Chronic Lumbar Pain—A Retrospective 3D-Computer-Assisted MRI Analysis Using iSix Software

Cited by 9 publications

References 33 publications

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Comparative Efficacy of Clinical Interventions for Sacroiliac Joint Pain: Systematic Review and Network Meta-analysis With Preliminary Design of Treatment Algorithm

3. Pain originating from the lumbar facet joints

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