Facet and Selective Nerve Root Blocks as a Diagnostic and Therapeutic Alternative in Patients with Chronic Low Back Pain
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Published:
Jun 17, 2023
Keywords:
Low back pain, facet block, selective root block, tomography, radioscopy
Main Article Content
Abstract
Introduction: Intra-articular facet blocks and selective nerve root blocks are useful as a diagnostic and therapeutic method for the management of chronic low back pain. The objective of this study was to describe and analyze the results of these blocks.
Materials and Methods: A retrospective cohort study was conducted with data from patients undergoing CT-guided intra-articular facet block and selective nerve root block between January 2014 and February 2015. The demographic information, the visual analog scale’s score before and after the block, and their relationships to the outcomes were analyzed.
Results: The study included 68 patients with intra-articular facet block and 89 with selective nerve root block. In both groups, pain improved significantly (p < 0.05). There was an association between the improvement in pain with intra-articular facet blocks and gender and age, and between the improvement achieved by selective nerve root blocks and the type of initial pain.
Conclusions: Intra-articular facet blocks and selective nerve root blocks are a useful diagnostic method in the management of chronic low back pain and their therapeutic action is significant, although studies are needed to know their analgesic effect in the medium and long term, in order to improve the quality of life of patients.
Materials and Methods: A retrospective cohort study was conducted with data from patients undergoing CT-guided intra-articular facet block and selective nerve root block between January 2014 and February 2015. The demographic information, the visual analog scale’s score before and after the block, and their relationships to the outcomes were analyzed.
Results: The study included 68 patients with intra-articular facet block and 89 with selective nerve root block. In both groups, pain improved significantly (p < 0.05). There was an association between the improvement in pain with intra-articular facet blocks and gender and age, and between the improvement achieved by selective nerve root blocks and the type of initial pain.
Conclusions: Intra-articular facet blocks and selective nerve root blocks are a useful diagnostic method in the management of chronic low back pain and their therapeutic action is significant, although studies are needed to know their analgesic effect in the medium and long term, in order to improve the quality of life of patients.
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How to Cite
Cinalli, M., Bazán, P. L., Medina, M., & Borri, Álvaro E. (2023). Facet and Selective Nerve Root Blocks as a Diagnostic and Therapeutic Alternative in Patients with Chronic Low Back Pain. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(3), 296-301. https://doi.org/10.15417/issn.1852-7434.2023.88.3.1514
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Clinical Research
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References
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Disponible en: https://www.reumatologiaclinica.org/es-pdf-S1699258X09001466
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10. González FJ, Adén M. Bloqueo radicular lumbar selectivo guiado por TAC. Alternativa para diagnóstico y
tratamiento de radiculopatías originadas por hernias discales y/o artrosis facetaria. Rev Fac Med 2011;31(2):11-4.
https://doi.org/10.30972/med.3122418
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12. Nielsen AJ, Criscuolo G, González Calvo S, Larrañaga N, Gallo JC, Kozima S. Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario. Rev Argent Radiol
2013;77(3):226-30. https://doi.org/10.7811/rarv77n3a08
13. Kanaan T, Abusaleh R, Al Jammal M, Al-Haded S, Al-Rafaiah S, Kanaan A, et al. The efficacy of therapeutic
selective nerve block in treating lumbar radiculopathy and avoiding surgery. J Pain Res 2020;13:2971-8.
https://doi.org/10.2147 / JPR.S276331
14. Wiswanathan VK, Mugesh Kanna R, Farhadi HF. Role of transforaminal epidural injections of selective nerve root blocks in the management of lumbar radicular syndrome-A narrative, evidence-bases review. J Clin Orthop Trauma 2020;11(5):802-9. https://doi.org/10.1016 / j.jcot.2020.06.004
15. Cohen SP, Wallacec M, Rauckd RL, Staceye BR. Unique aspects of clinical trials of invasive therapies for chronic
pain. Pain Rep 2018;4(3):e687. https://doi.org/10.1097/PR9.0000000000000687
16. Ospina Á, Campuzano D, Hincapié E, Vásquez, LF, Montoya E, Zapata IC. Eficacia del bloqueo facetario en
pacientes con síndrome facetario lumbar. Rev Colom Anestesiol 2012;40(3):177-82. Disponible en:
https://www.redalyc.org/articulo.oa?id=195124163003
2. O’Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: a critical review of consensus
and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol 2016;30(6):1-13.
https://doi.org/10.1016/j.berh.2017.05.001
3. Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, et al. Facet joint syndrome: from diagnosis to
interventional management. Insights Imaging 2018;9:773-89. https://doi.org/10.1007/s13244-018-0638-x
4. Won HS, Yang M, Kim YD. Facet joint injections for management of low back pain: clinically focused review.
Anesth Pain Med 2020;15(1):8-18. https://doi.org/10.17085/apm.2020.15.1.8
5. Cobeñas R, Flórez J, Chiaradia P, Ruiz Salgado K, Del Vedia M, Paba M, et al. Bloqueos nerviosos corticoideobupivacaína: ¿La mejoría post-procedimiento inmediato predice el éxito terapéutico a mediano plazo? Rev Argent Radiol 2021;2:31-54. https://doi.org/10.1055/s-0040-1721349
6. Hofmann U, Keller R, Walter C, Mittag F. Predictability of the effects of facet joint infiltratrion in the degenerate
lumbar spine when assessing MRI scans. J Orthop Surg Res 2017;12(1)180. https://doi.org/10.1186/s13018-017-0685-x
7. Wenger HC, Cifu AS. Treatment of low back pain. JAMA 2017;318(8):743-4. https://doi.org/10.1001/jama.2017.9386.
8. Insausti Valdivia J. Lumbalgia inespecífica: En busca del origen del dolor. Reumatol Clin 2009;5(S2):19-26.
Disponible en: https://www.reumatologiaclinica.org/es-pdf-S1699258X09001466
9. Arum-Kumar K, Jayaprasad S, Senthil K, Lohith H, Jayaprakash KV. The outcomes of selective nerve root block for disc induced lumbar radiculopathy. Malays Orthop J 2015;9(3):17-22. https://doi.org/10.5704/MOJ.1511.002
10. González FJ, Adén M. Bloqueo radicular lumbar selectivo guiado por TAC. Alternativa para diagnóstico y
tratamiento de radiculopatías originadas por hernias discales y/o artrosis facetaria. Rev Fac Med 2011;31(2):11-4.
https://doi.org/10.30972/med.3122418
11. Eyheremendy E. Infiltraciones percutáneas guiadas por imágenes en el manejo del dolor lumbar. Rev Asoc Argent Ortop Traumatol 2007;72:85-90. Disponible en: https://www.aaot.org.ar/revista/2007/n1_vol72/art15.pdf
12. Nielsen AJ, Criscuolo G, González Calvo S, Larrañaga N, Gallo JC, Kozima S. Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario. Rev Argent Radiol
2013;77(3):226-30. https://doi.org/10.7811/rarv77n3a08
13. Kanaan T, Abusaleh R, Al Jammal M, Al-Haded S, Al-Rafaiah S, Kanaan A, et al. The efficacy of therapeutic
selective nerve block in treating lumbar radiculopathy and avoiding surgery. J Pain Res 2020;13:2971-8.
https://doi.org/10.2147 / JPR.S276331
14. Wiswanathan VK, Mugesh Kanna R, Farhadi HF. Role of transforaminal epidural injections of selective nerve root blocks in the management of lumbar radicular syndrome-A narrative, evidence-bases review. J Clin Orthop Trauma 2020;11(5):802-9. https://doi.org/10.1016 / j.jcot.2020.06.004
15. Cohen SP, Wallacec M, Rauckd RL, Staceye BR. Unique aspects of clinical trials of invasive therapies for chronic
pain. Pain Rep 2018;4(3):e687. https://doi.org/10.1097/PR9.0000000000000687
16. Ospina Á, Campuzano D, Hincapié E, Vásquez, LF, Montoya E, Zapata IC. Eficacia del bloqueo facetario en
pacientes con síndrome facetario lumbar. Rev Colom Anestesiol 2012;40(3):177-82. Disponible en:
https://www.redalyc.org/articulo.oa?id=195124163003