Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

The Effect of Lumbar Medial Branch Block on Low Back Pain

  • Kim, Kyoung-Tae (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Park, Seung-Won (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Hong, Hyun-Jong (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kwon, Jeong-Taik (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Hwang, Sung-Nam (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • Published : 2006.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The goal of this study was to establish the benefit and prognostic factors of lumbar medial branch block[MBB] for low back pain. Methods : A retrospective analysis was based on the data obtained from 281 patients with low back pain, who visited our hospital between January 2001 and November 2004. Pain relief was evaluated at 2 weeks, 1 month and 3 months. The authors analyzed the results of MBB according to the patient's age, sex, symptom duration, pathologic condition, and presence of radiating pain. Results : Two hundred eighty one patients had sprain [151]. lumbar fracture [27], spinal stenosis [50], herniated lumbar disc [24] acute post-operative pain [8], and chronic post-operative pain [21] with success rate of 63.6%, 59.3%, 26.0%, 25.0%, 87.5% and 42.9%, respectively. The effects of MBB in sprain, lumbar fracture, and acute post-operative pain were significantly better than those in stenosis, herniated lumbar disc and chronic post-operative pain patients. The patients in young age group [<60 years], with short symptom duration [<6 months] and without radiating pain showed good response to lumbar MBB. Conclusion : The lumbar MBB appears to be safe and effective for low back pain in certain selected patients. Good prognostic factors were low back pain without surgical conditions and radiating pain, with short symptom duration [<6 months], and in relatively young age [<60 years] group.

Keywords

References

  1. Beaman DN, Graziano GP, Glover RA : Substance P innervation of lumbar spine facet joints. Spine 18 : 1044-1049, 1993 https://doi.org/10.1097/00007632-199306150-00014
  2. Benoist M : The natural history of lumbar disc herniation and radiculopathy. Joint Bone Spine 69 : 155-160, 2002 https://doi.org/10.1016/S1297-319X(02)00385-8
  3. Bogduk N, Long DM : Percutaneous lumbar medial branch neurotomy : a modification of facet denervation. Spine 5 : 193-200, 1980 https://doi.org/10.1097/00007632-198003000-00015
  4. Bogduk N, Long DM : The anatomy of the 'so-called articular nerves' and their relationship to facet denervation in the treatment of low back pain. J Neurosurg 51 : 172-177, 1979 https://doi.org/10.3171/jns.1979.51.2.0172
  5. Deleo JA, Winkelstein BA : Physiology of chronic spinal pain syndrome. Spine 27 : 2526-2537, 2002 https://doi.org/10.1097/00007632-200211150-00026
  6. Edgar MA, Ghadially JA : Innervation of the lumbar spine. Clin Orthop 15 : 35-41, 1976
  7. Fairbank J, Phnsent P : The Oswestry Disability Index. Spine 25 : 2940-2952, 2000 https://doi.org/10.1097/00007632-200011150-00017
  8. Jackson RP, Jacobs PR, Montesano PX : Facet joint injection in low-back pain : a prospective statistical study. Spine 13 : 966-971, 1988 https://doi.org/10.1097/00007632-198809000-00002
  9. Joy H, Ha SK, Kim SH, Lim DJ, Park JY, Suh JK : Prognostic factors of percutaneous radiofrequency neurotomy on the posterior primary ramus. J Korean Neurosurg Soc 33 : 51-55, 2003
  10. Kaplan M, Dreyfuss P, Halbrook B, Bogduk N : The ability of lumbar medial branch to anesthetize the zygapophysial joint : a physiologic challenge. Spine 23 : 1847-1852, 1998 https://doi.org/10.1097/00007632-199809010-00008
  11. Lippitt AB : The facet joint and its role in spine pain : The facet joint and its role in spine pain : Management with facet joint injections. Spine 9 : 746-750, 1984 https://doi.org/10.1097/00007632-198410000-00016
  12. Lynch MC, Taylor JF : Facet joint injection for low back pain : a clinical study. J Bone Joint Surg 68B : 138-141, 1986
  13. Maldjian C, Mesgarzadeh M, Tehranzadeh J : Diagnostic and therapeutic features of facet and sacroiliac joint injection. Radiol Clin North Am 36 : 497-508, 1998 https://doi.org/10.1016/S0033-8389(05)70039-7
  14. Manchikanti L, Pampati V, Fellows B, Bakhit CE : The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents. Curr Rev Pain 4 : 337-344, 2000 https://doi.org/10.1007/s11916-000-0016-4
  15. Mark RC, Houston T, Thulbourne T : Facet joint injection and facet nerve block : a randomized comparison in 86 patients with chronic low back pain. Pain 49 : 325-328, 1992 https://doi.org/10.1016/0304-3959(92)90239-8
  16. Michel B, Philippe B : Disc degeneration and low back pain. Degenerative disc disease. Philadelphia : Lippincott Williams & Wilkins, 2004, pp111-120
  17. Nam TG, Park SW : Lumbar dorsal ramus syndrome : management with radiofrequency facet rhizotomy. J Korean Neurosurg Soc 34 : 319-324, 2003
  18. Nash TP : Facet joints. Intra-articular sterioids or nerve block? Pain Clin 3 : 77-82, 1990
  19. Netter FH : The CIBA collection of medical illustrations, New Jersey : CIBA-GEIGY, 1987, Vol 8, Part 1, pp75-121
  20. North RB, Han M, Zahurak M, Kidd DH : Radiofrequency lumbar facet denervation. Analysis of prognostic factors. Pain 57 : 77-83, 1994 https://doi.org/10.1016/0304-3959(94)90110-4
  21. Perdersen HE, Blunck CFJ, Gardner E : The anatomy of lumbosacral posterior rami and meningeal branches of the spinal nerves (sinuvertebral nerves) : with an experimental study of their function. J Bone Joint Surg 38A : 377-391, 1956
  22. Rannu F, Poiraudeau S, Corvol M : Cotraintes mechnaiques et disque intervertebral lombaire. Reb Rhum (Suppl 4) 67 : 219-224, 2000 https://doi.org/10.1016/S1169-8330(00)80107-6
  23. Scott J, Huskisson EC : Graphic representation of pain. Pain 2 : 175-184, 1976 https://doi.org/10.1016/0304-3959(76)90113-5
  24. Seymour RA, Simpson JM, Charlton JE, Philips ME : An evaluation of length and end-phrase of visual analogue scales in dental pain. Pain 21 : 177-185, 1985 https://doi.org/10.1016/0304-3959(85)90287-8
  25. Ware JE Jr, Sherbourne CD : The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30 : 473-483, 1992 https://doi.org/10.1097/00005650-199206000-00002
  26. Wilki DJ, Savedra MC, Holzemer WL, Tesler MD, Paul SM : Use of the McGill Pain Questionnaire to measure pain : a meta-analysis. Nurs Res 39 : 36-41, 1990