Search Results (19)

Background: Lumbar facet joints are a significant source of chronic low back pain (CLBP), and medial branch blocks (MBBs) are the widely accepted reference diagnostic approach for diagnosis. However, clinical response varies. This study aims to investigate whether sagittal spinopelvic alignment parameters can predict the clinical efficacy of MBB in patients with facet-mediated CLBP. Methods: In this prospective observational study, 110 patients (aged 40–80) with facet-related CLBP underwent diagnostic MBBs using a double-block protocol. Spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), were measured on standing lateral radiographs. Clinical response was defined as a ≥80% reduction in Visual Analog Scale (VAS) scores. Data were analyzed using multivariate logistic regression and Receiver Operating Characteristic (ROC) curves. Results: Responders (n = 68) were significantly younger and had a lower BMI than non-responders (n = 42) (p < 0.05). Non-responders exhibited significantly higher PI–LL mismatch (18.6° ± 7.4 vs. 3.9° ± 4.2, p < 0.001), higher PT (23.6° ± 5.1 vs. 17.4° ± 4.5, p < 0.001), and lower LL (35.8° ± 7.2 vs. 45.2° ± 6.4, p < 0.001). ROC analysis identified a PI–LL mismatch threshold of >12.5° as the strongly associated with negative short-term diagnostic response (AUC = 0.892). Multivariate analysis confirmed that PI–LL mismatch > 12.5° was a potential associated factor within the investigated model of poor response (OR: 4.25, 95% CI: 2.10–8.60, p < 0.001), while age and BMI were not significant in the adjusted model. Conclusions: Sagittal spinopelvic malalignment, specifically an increased PI–LL mismatch, is strongly associated with reduced diagnostic utility of MBB. Integrating biomechanical assessment into clinical decision-making may improve patient selection and treatment outcomes for facet-mediated pain. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability and work absenteeism worldwide. Lumbar facet joint degeneration is a common source of chronic LBP, and when conservative treatment fails, interventional procedures may be indicated. Cryodenervation is a minimally invasive option that remains less extensively studied. This study aims to evaluate clinical outcomes, cost–utility, and return-to-work rates following lumbar facet joint cryodenervation. Methods: A retrospective study included 42 professionally active patients treated with lumbar facet joint cryoablation between 2020 and 2022 at a tertiary neurosurgical center. All patients had facet-mediated LBP confirmed by a positive diagnostic medial branch block. Pain (VAS), disability (ODI), and work status were assessed before and after treatment. ODI scores were converted to SF-6D utilities to estimate quality-adjusted life years (QALYs). Cost data were obtained from institutional records. Results: Mean ODI improved from 48.5 ± 12.8 to 36.6 ± 17.8, and mean VAS from 7.0 ± 1.7 to 3.8 ± 2.0. Mean SF-6D increased from 0.53 to 0.59, corresponding to a gain of 0.0103 QALYs over four months (annualized 0.0309). The mean procedure cost was 1905 PLN, resulting in approximately 185,000 PLN per QALY, which is within the national cost-effectiveness threshold. Overall, 58.5% of patients returned to work, with the highest rate in those aged 30–39 years (83.3%). Conclusions: Lumbar facet cryoablation provides meaningful pain relief and functional improvement at a favorable cost-effectiveness profile. Younger patients show higher return-to-work rates. Larger prospective studies are required to confirm these findings. Full article

Background/Objectives: Cervical facet joints are a common source of chronic neck pain, yet factors predicting treatment response to pulsed radiofrequency remain poorly defined. This study aimed to identify predictors of treatment success following ultrasound-guided cervical medial branch pulsed radiofrequency in patients with chronic cervical facet joint pain. Methods: This retrospective cohort study included 54 patients with chronic cervical facet joint pain who had positive response to diagnostic block. Pain intensity and functional disability were assessed at baseline and at 1-, 3-, and 6-months post-procedure, with treatment success defined as ≥50% pain reduction at 6 months. Results: The success rate was 35.2%, and multivariate logistic regression identified four independent predictors: presence of paraspinal tenderness on physical examination, shorter pain duration, lower baseline pain intensity, and lower baseline disability. Conclusions: These findings suggest that patients with localized facet joint pathology manifesting as paraspinal tenderness, shorter symptom duration, and lower baseline severity are most likely to benefit from this intervention, supporting early referral and careful clinical selection to optimize treatment outcomes. Full article

Low-back pain (LBP) is a leading cause of disability worldwide. When symptoms persist beyond 4–6 weeks, when red flags are suspected, or when precise patient selection for procedures is needed, imaging—primarily MRI (Magnetic Resonance Imaging)—becomes pivotal. The purpose is to provide a pragmatic, radiology-first roadmap that aligns an imaging phenotype with anatomical targets and appropriate image-guided interventions, integrating MRI-based phenotyping with image-guided interventions for subacute and chronic LBP. In this narrative review, we define operational MRI criteria to distinguish radicular from non-radicular phenotypes and to contextualize endplate/Modic and facet/sacroiliac degenerative changes. We then summarize selection and technique for major procedures: epidural and periradicular injections (including selective nerve root blocks), facet interventions with medial branch radiofrequency ablation (RFA), sacroiliac joint injections and lateral branch RFA, basivertebral nerve ablation (BVNA) for vertebrogenic pain, percutaneous disc decompression, minimally invasive lumbar decompression (MILD), and vertebral augmentation for painful fractures. For each target, we outline preferred and alternative guidance modalities (fluoroscopy, CT, or ultrasound), key safety checks, and realistic effect sizes and durability, emphasizing when to avoid low-value or poorly indicated procedures. This review proposes a phenotype-driven reporting template and a care-pathway table linking MRI patterns to diagnostic blocks and definitive image-guided treatments, with the aim of reducing cascade testing and therapeutic ambiguity. A standardized phenotype → target → tool approach can make MRI reports more actionable and help clinicians choose the right image-guided intervention for the right patient, improving outcomes while prioritizing safety and value. Full article

Background: The hemoglobin–albumin–lymphocyte–platelet (HALP) score integrates the immunonutritional and inflammatory status. We evaluated whether baseline HALP predicts the 3-month response after lumbar medial branch radiofrequency ablation (RFA), defined as a Visual Analogue Scale (VAS) reduction of ≥50% and an Oswestry Disability Index (ODI) reduction of ≥40%, and identified a Youden-optimal cut-off. The discrimination and calibration of multivariable models were also assessed. Methods: This single-center retrospective cohort (N = 120) included rigorously selected patients (≥50% pain relief after two comparative medial branch blocks) undergoing standardized RFA. Multivariable logistic regression was adjusted for age, sex, Body Mass Index (BMI), smoking status, paraspinal tenderness, and baseline scores. We quantified the Area Under the Receiver Operating Characteristic Curve (AUC), Hosmer–Lemeshow (HL) goodness-of-fit, Brier score, and calibration slope; optimism was corrected using a 500-bootstrap method. Results: Responses occurred in 64.2% (VAS) and 65.8% (ODI) of participants. HALP independently predicted ODI (OR = 1.06, 95% CI 1.02–1.09; p < 0.001) and VAS (OR = 1.05, 95% CI 1.02–1.08; p = 0.001). As a single predictor, HALP showed fair discrimination (AUC 0.717 [VAS], 0.731 [ODI]). The Youden cut-off of 39.8 yielded high sensitivity (~0.87) with modest specificity (~0.58–0.61). Multivariable AUCs were 0.744 (VAS) and 0.774 (ODI), optimism-corrected to 0.680 and 0.720; calibration was acceptable (HL p > 0.05; slopes ≈ 0.74–0.78; Brier 0.188/0.179). Conclusions: HALP is a simple, low-cost adjunct that independently predicts short-term pain and functional outcomes after lumbar medial branch RFA. Incorporation into post-block triage may refine selection, especially for functional improvement, pending prospective external validation and recalibration of the cut-off. Full article

Background: Stiff-knee gait commonly involves rectus femoris spasticity in patients with central nervous system lesions. Diagnostic nerve blocks aid in predicting treatment outcomes; however, current techniques may overlook multiple nerve branches that innervate the rectus femoris muscle, potentially resulting in an incomplete assessment of treatment outcomes. Methods: We present an ultrasound-guided approach that we currently use in our practice, using anatomical landmarks, including the femoral artery, the sartorius muscle, and the rectus femoris’ characteristic “J-shaped” internal tendon. The technique employs an “elevator” scanning method to identify all motor nerve branches (typically 2–3) entering the proximal third of the rectus femoris muscle. Each branch is blocked using an in-plane needle approach with 1–2 mL of 2% lidocaine. Results: The technique enables the visualization of hyperechoic nerve branches entering the rectus femoris muscle from medial to lateral, sometimes accompanied by small vascular branches that are identifiable with a Doppler ultrasound. Optimal ultrasound settings include probes >8 MHz, appropriate focus positioning, and dynamic range < 60 dB. The multi-branch approach produces rapid-onset motor weakness (5–10 min). Conclusions: This comprehensive multi-branch rectus femoris nerve block technique may enhance diagnostic accuracy for spasticity assessment, potentially leading to more informed treatment selection for stiff-knee gait. Full article

Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex pathology of this structure nerve may result in clinical consequences. We present a unique set of brachial plexus abnormalities involving the C4–C6 nerve roots, superior and middle trunks, additional communicating branches, and delayed median nerve union. Case Presentation: During the routine dissection of a 70-year-old female cadaver, several unique variations in the brachial plexus anatomy were identified. The C4 root contributed to C5 before the superior trunk formed, resulting in a superior trunk composed of C4–C6. The C5 root was located anterior to the anterior scalene muscle, whereas C6 maintained its usual posterior position. Additionally, an anterior communicating branch from the middle trunk to the posterior cord was observed. A communicating branch between the lateral and medial cords split into two terminal branches: one merged with the ulnar nerve, and the other joined the medial contribution of the median nerve. The median nerve contributions from the lateral and medial cords merged approximately two inches above the elbow. Conclusions: This rare combination of brachial plexus anomalies has not been previously described in the literature and is of significant clinical relevance. The additional anterior communicating branch from the middle trunk may suggest potential flexor muscle innervation by the posterior cord, which typically innervates extensor muscles. Additionally, the delayed convergence of the median nerve may provide a protective mechanism in cases of midshaft humeral fracture. Awareness of these peripheral nerve abnormalities is important for diagnostic imaging, surgery, or peripheral nerve blocks. Knowledge of such variations is critical for clinicians managing upper limb pathologies. Full article

Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP. This narrative review aims to provide an overview of the literature regarding facet joint pain and discusses the utility of medial branch blocks (MBBs) and intra-articular (IA) injections as diagnostic and therapeutic tools prior to radiofrequency ablation (RFA). RFA is considered the gold standard for managing FJP, employing techniques that include precise needle placement and stimulation parameters to disrupt pain signals. Promising alternatives such as cooled RFA and cryodenervation require further research on their long-term efficacy and safety. Endoscopic denervation and multifidus stimulation are emerging therapies that may benefit chronic LBP patients, but additional research is needed to establish their effectiveness. When conservative management fails, RFA provides significant and lasting relief in well-selected patients and has a favourable safety profile. The current literature does not support surgical interventions for FJP management. Full article

The sural nerve provides sensory innervation to the skin on the distal posterolateral third of the lower extremity. The morphological variants are characterized by high variability. However, it most commonly arises from a union of the medial sural cutaneous nerve and the peroneal communicating branch of the common fibular nerve. This article overviews the anatomical and clinical significance of the sural nerve. Despite the remarkable development of genetic diagnostics, sural nerve biopsy is still a very important tool to diagnose peripheral neuropathies such as diabetic, vascular and inflammatory neuropathies. Furthermore, the sural nerve is also commonly transplanted due to its characteristics. Such a procedure is applicable in cases of segmental nerve loss, but it is also used to restore potency in patients after radical prostatectomy. The knowledge of anatomical variants of the sural nerve is also crucial as it allows to minimize its damage during surgical procedures. Furthermore, during an ankle surgery, a nerve block can be used to complement anesthesia. The major aim of this work is to review contributions of the sural nerve to physiological and pathophysiological processes. Full article

Chronic lumbar facet pain is commonly treated with fluoroscopy-guided facet medial branch blocks (FMBBs). However, the associated radiation exposure of both patients and clinicians is a growing concern. This study aimed to compare radiation doses and fluoroscopy times between two techniques, i.e., oblique and posterior–anterior (PA) fluoroscopic approaches, while also examining the impact of physician experience on these metrics. A retrospective analysis was conducted on 180 patients treated at Mersin University Hospital Pain Clinic between January and July 2024. Patients were divided into two groups: 90 received the oblique technique (Group O) and 90 received the AP technique (Group A). Radiation dose and fluoroscopy time data were collected for each patient. The AP technique was associated with significantly lower radiation doses (mean 66 mGy) and shorter fluoroscopy times (mean 28 s) compared to the oblique technique (mean radiation dose of 109 mGy and fluoroscopy time of 46 s) (p < 0.001). Physician experience also influenced these outcomes, with more experienced physicians consistently using less radiation. The AP technique should be considered for FMBBs, as it reduces radiation exposure while maintaining procedural efficiency, highlighting the importance of experience in optimizing outcomes. Full article

Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise. Full article

Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery. Full article

(1) Background: Lower back pain is often caused by lumbar facet joint syndrome. This study investigated the effectiveness of three different injection methods under ultrasound guidance in treating elderly patients with lumbar facet joint syndrome. The difficulty in performing these injections was also evaluated; (2) Methods: A total of 60 elderly patients with facet joint syndrome as the cause of lower back pain were recruited and divided into 3 groups. Group 1 received medial branch block (MBB). Group 2 received intra-articular facet joint injections. Group 3 received injection into the multifidus muscle portion that covers the facet joint. Five percent dextrose water (D5W) was used as the injectant. The visual analog scale (VAS) was used to measure the degree of lower back pain; (3) Results: Before the injection treatments, the VAS score averaged about 7.5. After three consecutive injection treatments (two weeks interval), the VAS score decreased significantly to an average of about 1 in all 3 groups, representing mild to no pain. Between group analyses also did not reveal significant statistical differences, suggesting that these procedures are equally effective; (4) Conclusions: Ultrasound-guided injection of the multifidus muscle may be a feasible option in treating elderly patients with lower back pain caused by facet joint syndrome as it is easier to perform as compared to MBB and intra-articular facet joint injection. Full article

Spinal pain is one of most frequent complaints of the general population, which can cause decreased activities of daily living and absence from work. Among numerous therapeutic methods, spinal injection is one of the most effective treatments for spinal pain and is currently widely applied in the clinical field. In this review, spinal injection is discussed from a surgeon’s perspective. Recently, although the number of spinal surgeries has been increasing, questions are arising as to whether they are necessary. The failure rate after spinal surgery is high, and its long-term outcome was reported to be similar to spinal injection. Thus, spinal surgeries should be performed conservatively. Spinal injection is largely divided into diagnostic and therapeutic blocks. Using diagnostic blocks, such as the diagnostic selective nerve root block, disc stimulation test, and diagnostic medial branch block (MBB), the precise location causing the pain can be confirmed. For therapeutic blocks, transforaminal nerve root injection, therapeutic MBB, and percutaneous epidural neuroplasty are used. When unbearable spinal pain persists despite therapeutic spinal injections, spinal surgeries can be considered. Spinal injection is usefully used to identify the precise location prior to a patient undergoing injection treatment or surgery and can reduce pain and improve quality of life, and help to avoid spinal surgery. Pain physicians should treat patients with spinal pain by properly utilizing spinal injection. Full article

Background: The aim of this retrospective uncontrolled article is to illustrate a technique of neurotomy of the sensitive branches of S1 S2 S3 in RFA that appears to result in a better success rate and longer-lasting pain relief. Methods: 40 patients were treated, 26 females and 14 males, with an average age of 74 (92–55). After the examination, the patients underwent an ultrasound-guided diagnostic block of the affected sacroiliac joint. Only patients who presented pain relief greater than 60% after the diagnostic block were candidates for the RFA procedure. The procedure was always performed in the operating room on an outpatient basis. After obtaining the best fluoroscopic visualization of the joint to be treated, two RFA cannulae were placed starting from the lower medial margin parallel to the SIJ to perform a bipolar RFA along the entire medial margin of the SIJ. Lidocaine 2% and hypertonic saline 2 mEq/mL were used for each RFA level. Patients were followed-up at 3, 6, 12, 18, and 24 months by evaluating the NRS and SF-12. Results: Patients reported extreme satisfaction with the procedure performed and reported a significant improvement in NRS and SF-12 at FU visits. No adverse events occurred. Conclusions: Bipolar RFA treatment of the sacroiliac joint with the use of a hypertonic saline solution appears to improve the success of the method and its durability. We are inclined to believe that the use of hypertonic saline may significantly increase the lesion area and result in a greater effect on the sensory branches. Full article