Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy.

BACKGROUND: Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. METHODS: Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. RESULTS: The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. CONCLUSIONS: The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.

The surgical treatment of subaxial acute cervical spine facet dislocations in adults: a systematic review and meta-analysis.

Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults. This study was based on a systematic literature review and meta-analysis, registered in Prospero (CRD42021279249). The PICO question was composed of adults with acute cervical spine traumatic facet dislocations submitted to anterior or posterior surgical approaches, associated or not with cranial traction for reduction. Each surgical technique was compared to the other. The primary clinical outcomes included neurological improvement or worsening and surgical success/failure rates. The anterior approach without cranial traction was efficient in reducing facet displacements. Skull traction was an efficient and immediate method to achieve spine dislocation reductions. Differences were not present among techniques regarding neurological improvement. There were no surgical failures in patients operated on via the posterior approach. The need to decompress and stabilize the cervical spine can be achieved by anterior or posterior surgical approaches, and there is no clear answer as to which initial approach is superior to the other.

Pedicle Screws and Facet Violation - The importance of the Angle between the Facet and the Screw / Parafusos pediculares e violação facetária - A importância do ângulo entre a faceta e o parafuso

Abstract Objective To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed. Methods Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance). Results A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (p< 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (p< 0.001). Conclusion The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.

Resumo Objetivo Verificar se, independente da técnica de colocação do parafuso, há uma distância ou angulação segura em relação as facetas para que os parafusos sejam colocados de modo a evitar a violação da articulação facetária. Métodos Estudo retrospectivo, comparativo, não randomizado, em centro único. Foram avaliados em tomografia computadorizada axial: o ângulo do parafuso/barra em relação a linha média, o ângulo do centro das facetas em relação a linha média, a distância entre a cabeça do parafuso/barra até a linha média, e a distância do centro das facetas até a linha média; a violação da articulação facetária será avaliada em uma gradação de 0 a 2. Serão também calculados a diferença entre o ângulo do parafuso e ângulo da faceta (Δ Ångulo) e também a diferença entre a distância da faceta e a distância do parafuso (Δ Distância). Resultados Um total de 212 pacientes e 397 facetas foram analisados (196 do lado esquerdo e 201 do lado direito). Destes, 303 foram não violados (grau 0), correspondendo a 76,32%, e 94 sofreram algum tipo de violação (grau 1 e 2), correspondendo a 23,68%. A média do Δ ângulo foi de 9,87° +/− 4,66° (grau 0) e de 3,77° +/− 4,93° em facetas (grau 1 e 2) (p< 0.001), e o Δ distância médio nos casos em que não houve violação foi de 0,94 unidades aleatórias (u.a.) +/− 0,39 u.a., enquanto o Δ distância de casos G1 e G2 foi de 0,56 u.a. +/− 0,25 u.a. (p< 0.001). Conclusão As medidas de ângulo e distância entre faceta e parafuso, podem auxiliar na colocação de parafusos. Esses parâmetros podem ser utilizados como medidas de segurança com o uso mais frequentes das técnicas de navegação cirúrgica.

Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines.

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.

Lumbar Radiofrequency Ablation: Procedural Technique.

Lumbar radiofrequency ablation is indicated for the treatment of chronic axial low back pain that is mediated by facet arthropathy which has failed more conservative treatment options. This article details proper equipment and medications, patient positioning and setup, step-by-step instructions for multiplanar fluoroscopic visualization, cannula placement, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video (Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A90) accompanies this paper.

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients' final outcomes.

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches? / Deslocamentos facetários cervicais traumáticos: abordagem anterior, posterior ou combinada?

ABSTRACT Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

RESUMO O tratamento dos deslocamentos facetários cervicais traumáticos (DFC) é preferencialmente cirúrgico, conforme a literatura pertinente, mas há dúvidas quanto a melhor forma de abordagem da coluna: anterior, posterior ou combinada. Realizamos revisão sistemática para avaliar as indicações da abordagem anterior e da posterior nos DFC. A abordagem anterior permite restaurar a lordose cervical, com menor dor no pós-operatório e menos problemas relacionados a ferida cirúrgica. A abordagem posterior permite redução direta dos deslocamentos, bem como pode resultar em uma fixação biomecanicamente mais robusta. Acessos combinados são usados em casos complexos. Embora ambas possam ser usadas, há alguns pacientes que possivelmente se beneficiem preferencialmente de uma abordagem ao invés da outra, como discutido no presente manuscrito. Cirurgiões de coluna devem ser habilitados a realizar ambos os procedimentos para melhor os resultados do tratamento dos DFC.

Radiofrequency Denervation for Facet Syndrome: A Meta-Analysis of Treatment Outcomes / Denervação de síndrome facetária por radiofrequência: metanálise de resultados de tratamentos

Objective The aim of this study was to carry out a systematic literature review on the facet syndrome and a meta-analysis of the outcomes of radiofrequency denervation in patients presenting with the syndrome. Methods A systematic literature review was performed based on 52 articles published from 1999 to 2013, available at Bireme, Scielo, PubMed, and MEDLINE databases. The meta-analysis comprises eight case-control studies, found during the literature review, totaling 440 patients. The heterogeneity of the collected data was assessed using the chi-square test (χ2). To estimate the effect of the proposed correlation, we combined the values of each study with the Mantel-Haensze test, which has fixed effects, using the BioEstat 5.0 software. Results The selected studies were statistically relevant when grouped, determining an effect in favor of the use of facet denervation as a technique capable of relieving chronic low back pain in pre-determined periods of follow-up (OR » 1.251; 95% CI: 1.028­1.524). Conclusion The results of the systematic literature review and meta-analysis herein presented may be used for the creation of diagnosis and management protocols for facet syndrome, and can also attract the interest of other researchers to conduct further studies on the theme.

Objetivo Este estudo teve como objetivo elaborar uma revisão sistematizada sobre síndrome facetária e umametanálise sobre os desfechos do tratamento neurocirúrgico com denervação por radiofrequência em pacientes acometidos por esta síndrome. Métodos A revisão sistematizada foi elaborada com base em 52 artigos publicados de 2000 a 2013, disponíveis nas bases de dados eletrônicos Bireme, Scielo, PubMed e MEDLINE. A metanálise foi composta por oito casos-controle, selecionados durante a revisão, totalizando 440 pacientes. Os dados coletados foram avaliados quanto à sua heterogeneidade pelo teste qui-quadrado (χ2). Para estimar o efeito da correlação proposta, os valores de cada estudo foram combinados com o teste de Mantel- Haensze, que tem efeitos fixos, utilizando o software BioEstat 5.0. Resultados Os estudos selecionados são estatisticamente relevantes quando agrupados, determinando um efeito a favor do uso da denervação facetária como técnica capaz de diminuir a lombalgia crônica em seguimentos pré-determinados, mostrando OR de 1,251 e IC95% entre 1,028 e 1,524. Conclusão Os resultados da revisão sistemática de literatura e da metanálise aqui apresentados podem servir de base para a criação de protocolos de diagnóstico e conduta da síndrome facetária, assim como despertar o interesse de outros pesquisadores para a condução de novos estudos sobre o tema.

Radiofrequency Neurolysis for Lumbar Pain Using a Variation of the Original Technique.

BACKGROUND: Zygapophysial joint arthrosis is a pathology related with axial lumbar pain. The most accepted treatment, after failure of medical management, is the thermal denervation of the medial branch. Nonetheless, the placement of the heat probe remains a challenge to surgeons, even when using the fluoroscope. Using a variation of Shealy's and Bogduk's original techniques, which includes ablation of the medial branch and the nerves present in the joint capsule, we hypothesize that we can obtain similar outcomes to those found in the literature. OBJECTIVE: To present the results attained over the last 8 years in the treatment of axial lumbar pain from zygapophysial joints degeneration, by employing a variation of the lumbar medial branch neurotomy technique, called 360-degree facet rhizotomy with radiofrequency. STUDY DESIGN: Retrospective evaluation. SETTING: Spine Center - Minimally Invasive Surgery in Bogotá, Colombia. METHODS: A medical chart review was conducted for patients diagnosed with axial lumbar pain from zygapophysial joint arthrosis and treated with 360-degree facet rhizolysis with a high frequency radiofrequency energy source between 2008 and 2014. Data were evaluated under modified MacNab and pre- and postoperative visual analog scale (VAS) criteria. RESULTS: We obtained a total of 73 patients. The average population age was 58.6 years. The preoperative VAS obtained was 7.3, which changed to 1.7 one year after the procedure. The MacNab criteria 12 months after the surgery gave satisfactory outcomes (excellent and good) from 91.7% of the patients. LIMITATIONS: This retrospective study includes inherent limitations and only offers one year follow-up data. CONCLUSIONS: Thermal therapy for zygapophysial joint arthrosis constitutes a safe and effective technique. The one year follow-up data presented here show that the ablation of the medial branch and nerves present in the joint capsule leads to satisfactory results in a high percentage of patients.

Radiofrequency denervation for facet joint low back pain: a systematic review.

STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials. OBJECTIVE: To assess treatment effects (benefits and harms) of radiofrequency denervation for patients with facet joint-related chronic low back pain. SUMMARY OF BACKGROUND DATA: There is no consensus regarding the treatment efficacy of facet joint radiofrequency denervation (FJRD) and how it compares with nerve blockades and joint infiltration with anesthetics and/or corticosteroids. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS for randomized controlled trials that compared FJRD with blockades, infiltrations, or placebo. Primary outcomes were pain, functional status, and quality of life. Secondary outcomes were cost-effectiveness and complications. RESULTS: Fifteen studies were selected and 9 were eligible. Overall quality of evidence was rated low to moderate. The evidence favored FJRD regarding pain control. There was no sufficient evidence for cost-effectiveness and complications. CONCLUSION: The available evidence reviewed in this study should be interpreted with caution. The data indicate that FJRD is more effective than placebo in pain control and functional improvement and is also possibly more effective than steroid injections in pain control. Complications and adverse effects were not sufficiently reported to allow comparisons, and there was no evidence for cost-effectiveness. High-quality randomized controlled trials addressing pain, function, quality of life, complications, and cost-effectiveness are urgently needed. LEVEL OF EVIDENCE: 1.

In vivo cervical facet joint capsule deformation during flexion-extension.

STUDY DESIGN: Nonrandomized controlled cohort. OBJECTIVE: To characterize subaxial cervical facet joint kinematics and facet joint capsule (FJC) deformation during in vivo, dynamic flexion-extension. To assess the effect of single-level anterior arthrodesis on adjacent segment FJC deformation. SUMMARY OF BACKGROUND DATA: The cervical facet joint has been identified as the most common source of neck pain, and it is thought to play a role in chronic neck pain related to whiplash injury. Our current knowledge of cervical facet joint kinematics is based on cadaveric mechanical testing. METHODS: Fourteen asymptomatic controls and 9 C5-C6 arthrodesis patients performed full range of motion flexion-extension while biplane radiographs were collected at 30 Hz. A volumetric model-based tracking process determined 3-dimensional vertebral position with submillimeter accuracy. FJC fibers were modeled and grouped into anterior, lateral, posterior-lateral, posterior, and posterior-medial regions. FJC fiber deformations (total, shear, and compression-distraction) relative to the static position were determined for each cervical motion segment (C2-C3 through C6-C7) during flexion-extension. RESULTS: No significant differences in the rate of fiber deformation in flexion were identified among motion segments (P = 0.159); however, significant differences were observed among fiber regions (P < 0.001). Significant differences in the rate of fiber deformation in extension were identified among motion segments (P < 0.001) and among fiber regions (P = 0.001). The rate of FJC deformation in extension adjacent to the arthrodesis was 45% less than that in corresponding motion segments in control subjects (P = 0.001). CONCLUSION: In control subjects, FJC deformations are significantly different among vertebral levels and capsule regions when vertebrae are in an extended orientation. In a flexed orientation, FJC deformations are different only among capsule regions. Single-level anterior arthrodesis is associated with significantly less FJC deformation adjacent to the arthrodesis when the spine is in an extended orientation. LEVEL OF EVIDENCE: 4.