Current reviews in musculoskeletal medicine
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Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. ⋯ Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.
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Curr Rev Musculoskelet Med · Mar 2009
Review article: radiofrequency neurotomy for the treatment of sacroiliac joint syndrome.
We review here the latest studies on efficacy of and techniques employed in radiofrequency neurotomy of the sacroiliac joint. Radiofrequency neurotomy has been shown to have limited evidence in treating sacroiliac joint syndrome. Variability in results has been attributed to individual nerve patterns, improper diagnosis, and selection of patients, as well as variability in the procedure itself. Future studies will be needed to focus on the type of radiofrequency neurotomy and positioning of electrodes to better evaluate efficacy.
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Curr Rev Musculoskelet Med · Dec 2008
Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections.
Lumbar interlaminar and transforaminal epidural injections are used in the treatment of lumbar radicular pain and other lumbar spinal pain syndromes. Complications from these procedures arise from needle placement and the administration of medication. Potential risks include infection, hematoma, intravascular injection of medication, direct nerve trauma, subdural injection of medication, air embolism, disc entry, urinary retention, radiation exposure, and hypersensitivity reactions. ⋯ We performed a comprehensive literature review through a Medline search for relevant case reports, clinical trials, and review articles. Complications from lumbar epidural injections are extremely rare. Most if not all complications can be avoided by careful technique with accurate needle placement, sterile precautions, and a thorough understanding of the relevant anatomy and contrast patterns on fluoroscopic imaging.
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Curr Rev Musculoskelet Med · Jun 2008
The role of intradiscal steroids in the treatment of discogenic low back pain.
LBP is one of the most common reasons for visiting a doctor and is the most common cause of disability under age 45. Amongst a variety of etiologies, internal disc disruption (IDD) has been postulated as an important cause of low back pain. Treating discogenic low back pain continues to be a challenge to physicians. ⋯ Both steroids and non-steroidal anti-inflammatory drugs have partial effectiveness in treating pain associated with inflammation. Therefore, the rationale for using intradiscal steroids is to suppress the inflammation within the disc, thereby alleviating the patient's symptoms. The goal of this article is to review the literature regarding the efficacy of intradiscal steroids to treat low back pain of discogenic origin.