Neurostimulating control of the blocks of medial branches of posterior rami of spinal nerves in treatment of the “pain facet syndrome” of lumbar spondyloarthritis and planning of denervation of zygapophysial joints

Authors

  • Олександр Вячеславович Перфільєв State Institution “Prof. M. I. Sytenko Institute of Spine and Joint Pathology of National Academy of Medical Sciences of Ukraine” Pushkinskaya str., 80, Kharkiv, Ukraine, 61024, Ukraine https://orcid.org/0000-0002-4180-5759

DOI:

https://doi.org/10.15587/2519-4798.2016.85422

Keywords:

pain facet-syndrome, neurostimulation, medial branches of posterior rami of spinal nerves

Abstract

The aim of research is an improvement of blocks of medial branches of posterior rami of spinal nerves (MB PR SN) in treatment of the “pain facet syndrome” of lumbar spondyloarthritis and planning of denervation of zygapophysial joints by the additional identification of target nerves by neurostimulator.

Material and methods. 96 patients with lumbar “facet syndrome” (40 men and 56 women) 18 -75 years old. All patients underwent blocks of MB PR SN under “С-arm” control and electrostimulation by “B BRAUN Stimuplex Dig RC Nerve Stimulator”. The effectiveness of MB PR SN blocks was evaluated during a week, in 1, 3, 6 and 12 months by VAS and questionnaire Roland-Morris.

Results of research. At the beginning 524 blocks were done at the level L3-S1 in 96 (100 %) patients. 420 blocks in 70 patients at the levels L3-L4, L4-L5, L5-S1, and 104 ones in 26 patients at the levels L4-L5, L5-S1. The positive dynamics was observed during 3 months with decease of pain syndrome from 50 % to 72 %, and improvement of living activity from 50 % to 67 %. In 54 patients (56 %), the blocks were repeated at 7 day. That is 270 blocks in 45 patients at the levels L3-L4, L4-L5, L5-S1, and 36 blocks in 9 patients at the levels L4-L5, L5-S1. The positive dynamics was observed during 6 months with decrease of pain syndrome from 50 % to 58 %, and improvement of living activity from 38 % to 63 %. MB PR SN neurotomy was done in 18 patients (18,7 %) after two blocks under endoscopic control with decrease of pain syndrome by 63 %-86 % depending on age and improvement of living activity by 50 % - 75 % more than 1 year.

Conclusion. Electric stimulation of multi-sectional muscles during MB PR SN blocks allows reliably identify the necessary nerve rami, decrease the falsely positive and falsely negative results at anatomic variation of nerves location that gives a reason for using this method for both treatment of pain facet-syndrome and planning of ZJ denervation in patients with lumbar spondyloarthritis

Author Biography

Олександр Вячеславович Перфільєв, State Institution “Prof. M. I. Sytenko Institute of Spine and Joint Pathology of National Academy of Medical Sciences of Ukraine” Pushkinskaya str., 80, Kharkiv, Ukraine, 61024

Postgraduate student, orthopedic-traumatic surgeon

The division of minimally invasive and instrumental spine surgery

References

  1. Binder, D. S., Nampiaparampil, D. E. (2009). The provocative lumbar facet joint. Current Reviews in Musculoskeletal Medicine, 2 (1), 15–24. doi: 10.1007/s12178-008-9039-y
  2. Sirenko, A. A. (2011). Diagnostika, profilaktika i lecheni recidivov spondiloartralgii posle denervacii poyasnichnyh dugootrostchatyh sustavov. Kharkiv, 20.
  3. Radchenko, V., Kutsenko, V., Perfiliev, O., Popov, A. (2016). Neurotomy of the medial posterior branches of spinal nerves under endoscopic control in the treatment of lumbar syndrome spondyloarthralgiy. Orthopaedics, traumatology and prosthetics, 3, 16–21. doi: 10.15674/0030-59872016316-21
  4. Manchikanti, L., Pampati, V., Singh, V., Falco, F. J. (2013). Assessment of the escalating growth of facet joint interventions in the medicare population in the United States from 2000 to 2011. Pain Physician, 16 (4), E365–E378.
  5. Manchikanti, L., Kaye, A. D., Boswell, M. V., Bakshi, S., Gharibo, C. G., Grami, V., Grider, J. S. et. al. (2015). A systematic review and best evidence synthesis of the effec-tiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician, 18 (4), E535–E582.
  6. Park, J. W., Cheon, M. W., Lee, M. H. (2016). Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices. Annals of Rehabilitation Medicine, 40 (4), 575–582. doi: 10.5535/arm.2016.40.4.575
  7. Amrhein, T. J., Joshi, A. B., Kranz, P. G. (2016). Technique for CT Fluoroscopy–Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation. American Journal of Roentgenology, 207 (3), 631–634. doi: 10.2214/ajr.15.15694
  8. Bogduk, N., Wilson, A. S., Tynan, W. T. (1982). The human lumbar dorsal rami. Journal of Anatomy, 134 (2), 383–397.
  9. Saito, T., Steinke, H., Miyaki, T., Nawa, S., Umemoto, K., Miyakawa, K. et. al. (2013). Analysis of the Posterior Ramus of the Lumbar Spinal Nerve. Anesthesiology, 118 (1), 88–94. doi: 10.1097/aln.0b013e318272f40a
  10. Cohen, S. P., Raja, S. N. (2007). Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain. Anesthesiology, 106 (3), 591–614. doi: 10.1097/00000542-200703000-00024
  11. Rocha, I., Cristante, A., Marcon, R., Oliveira, R., Letaif, O., Barros Filho, T. (2014). Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics, 69 (8), 529–534. doi: 10.6061/clinics/2014(08)05
  12. Cohen, S. P., Moon, J. Y., Brummett, C. M., White, R. L., Larkin, T. M. (2015). Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation. Regional Anesthesia and Pain Medicine, 40 (4), 376–383. doi: 10.1097/aap.0000000000000229
  13. Radchenko, V., Perfiliev, O., Larichev, V. (2016). The peculiarities of location of medial twigs of posterior branches of spinal nerves (topographic-anatomical studies). Orthopaedics, traumatology and prosthetics, 1, 78–83. doi: 10.15674/0030-59872016178-83
  14. Cohen, S. P., Williams, K. A., Kurihara, C., Nguyen, C., Shields, C., Kim, P. et. al. (2010). Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation. Anesthesiology, 113 (2), 395–405. doi:10.1097/aln.0b013e3181e33ae5
  15. Van Zundert, J., Mekhail, N., Vanelderen, P., van Kleef, M. (2010). Diagnostic Medial Branch Blocks before Lumbar Radiofrequency Zygapophysial (Facet) Joint Denervation. Anesthesiology, 113 (2), 276–278. doi: 10.1097/aln.0b013e3181e33b02

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Published

2016-12-28

How to Cite

Перфільєв, О. В. (2016). Neurostimulating control of the blocks of medial branches of posterior rami of spinal nerves in treatment of the “pain facet syndrome” of lumbar spondyloarthritis and planning of denervation of zygapophysial joints. ScienceRise: Medical Science, (12 (8), 31–36. https://doi.org/10.15587/2519-4798.2016.85422

Issue

No. 12 (8) (2016)

Section

Medical Science

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Copyright (c) 2016 Олександр Вячеславович Перфільєв

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