Efficacy and outcome predictors of fluoroscopy-guided facet joint injection for spondylolysis.

OBJECTIVE: To assess the efficacy of fluoroscopy-guided facet joint injection for symptomatic spondylolysis and to analyze the outcome predictors. MATERIALS AND METHODS: This study included 108 patients who underwent fluoroscopy-guided facet joint steroid injection for symptomatic spondylolysis with follow-up medical records from January 2013 to December 2016. Among them, 47 patients underwent concomitant epidural steroid injection. Response to injection was assessed at the initial follow-up. The symptom-free interval was analyzed using the Kaplan-Meier method. Outcome predictors were statistically analyzed using independent t test and Chi-square test. RESULTS: The facet joint injection was effective in 52 of 108 (48.1%) patients at initial follow-up. Recurrence was reported in 21 of these 52 (40.4%) patients. For the 52 patients in whom facet joint injection was effective, the median symptom-free interval was 298 days (95% confidence interval, 29-567 days). No significant difference was found in the response between the group with facet joint injection only (n = 61) and the group with facet joint injection and additional ESI (n = 47). Additionally, no significant outcome predictors were detected. CONCLUSIONS: Fluoroscopy-guided facet joint injection may potentially be an effective therapy for providing prolonged pain relief and avoiding unnecessary surgery for symptomatic spondylolysis without significant outcome predictors.

Accuracy and efficacy of fluoroscopy-guided pars interarticularis injections on immediate and short-term pain relief.

PURPOSE: To determine the accuracy and short-term efficacy of fluoroscopy-guided steroid/anesthetic injections for symptomatic pars interarticularis (pars) defects. MATERIALS AND METHODS: Following IRB approval, all fluoroscopically guided pars injections from a single institution (6/2010 to 3/2016) were retrospectively and independently reviewed by two MSK radiologists. The radiologists evaluated the fluoroscopic images to determine if all of the pars injections associated with each procedure were intra-pars (n = 57 procedures; 106 pars injections), peri-pars (n = 3 procedures; three pars injected), or a combination of intra-pars and peri-pars (n = 6 procedures; 12 pars injected). The patients were asked their pain score (graded on a scale of 0-10) pre-injection, 5-10 min and 1-week post-injection. Age, gender, and fluoroscopic times were recorded. Statistical analysis was performed on the all intra-pars injections only. RESULTS: Exact inter-reader agreement was present in 92 % (112/121) of the injections, with 57 of the procedures (106 pars injections) performed on 41 patients (mean age 36; 18 M, 23 F) all intra-pars. The mean pre-injection and 5-10 min post-injection reduction in pain for the all intra-pars injections was -3.0 units (95 % CI: [-3.9, -2.1] units; p < 0.001) with a mean 1-week post-injection (n = 21 procedures; 38 pars) reduction in pain of -0.7 units (95 % CI [-1.5, 0.0]; p = 0.06). The geometric mean fluoroscopic time per pars injected was 42 s. CONCLUSIONS: Over 92 % of fluoroscopically guided injections for symptomatic spondylolysis are technically successful with minimum fluoroscopic time, resulting in statistically significant pain reduction immediately post-injection and a trend in pain reduction 1-week post-injection.

CT-guided oxygen-ozone treatment for first degree spondylolisthesis and spondylolysis.

Aim of this study was to assess the therapeutic outcome of CT-guided periganglionic infiltration of oxygen-ozone and injection of the gas mixture into the lysis points in patients with first grade spondylolisthesis and spondylolysis. We selected 18 patients presenting with low back pain and sciatica resistant to physical and medical management with a radiological diagnosis of spondylolisthesis and spondylolysis subsequently confirmed on CT scan. Following CT-guided bilateral periganglionic O2-O3 infiltration and injection into the lysis points, 15 patients (83.3%) obtained a complete remission of pain. None of the patients reported pain recurrence at clinical follow-up visits one, three and six months after treatment. Oxygen-ozone therapy administered in this way is even more effective than CT-guided periganglionic infiltration alone as it has an additional anti-inflammatory and analgesic effect on the nerve structures in the neural arch, namely Luschka's recurrent nerve.

[Clinical observation on Xiaoyusan plaster and Daoyin in the treatment of disease of cervical vertebrae].

OBJECTIVE: To investigate the effects of Xiaoyusan plaster and Daoyin in the treatment of cervical vertebrae disease, to search new methods in the treatment of cervical vertebrae disease. METHODS: From May 2007 to April 2008, 63 patients with disease of cervical vertebrae were treated. By odd or even numbers in random digits table, the patients were randomly divided into two groups included treatment group and control group. Thirty-three patients in the treatment group were treated with Xiaoyusan plaster and Daoyin included 21 males and 12 females with an average age of (30.60+/-7.89) years ranging from 20 to 49. Thirty patients in the control group were treated with Votalin Sustained Release Tablets included 16 males and 14 females with an average age of (32.43+/-8.00) years ranging from 20 to 49. The pain, pressing pain, activity of cervical vertebrae were observed before and after treatment in two groups. RESULTS: Compared the scores before and after treatment in treatment group: pain (t=8.953, P<0.001); pressing pain (t=7.867, P<0.001); activity (t=6.918, P<0.001). Compared the scores before and after treatment in control group: pain (t=8.733, P<0.001); pressing pain (t=7.663, P<0.001); activity (=5.066, P<0.001). The symptoms such as pains, pressing pain, movement restriction improved significantly in two groups. CONCLUSION: Xiaoyusan plaster and Daoyin are one of the effective methods in the treatment of disease of cervical vertebrae, especially can improve symptoms and correct dynamic balance of cervical vertebrae.