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Intervertebral Disc Degeneration in Clinics
Published in Raquel M. Gonçalves, Mário Adolfo Barbosa, Gene and Cell Delivery for Intervertebral Disc Degeneration, 2018
Pedro Santos Silva, Paulo Pereira, Rui Vaz
Nonspecific LBP can be related to the mechanical structures of the spine, such as the vertebrae and their articulations (intervertebral discs and facet joints), apposed joints (hip or sacroiliac joint), muscles, and ligaments. Injury or inflammation of these structures can cause a mechanical type of pain, which exacerbates with movement and exertion and tends to increase to the end of the day, and there is some relief with resting. The pain can radiate to the groin, buttocks, and thigh, which is call referred pain, a pain perceived at a different location from the site of the painful stimulus; this form of pain typically has a proximal radiation above the knee and is less well localized than a pain originating from a nerve root. There are some clinical aspects that can suggest an intervertebral disc origin for a LBP (Tonosu et al. 2017): a discogenic pain the can be triggered after sustained loading (sitting too long) and lumbar flexion, especially with knee extension (washing one’s face), and can radiate to the anterior thigh. This condition should be differentiated from facet syndrome, a condition that results from facet joint osteoarthritis, in which the back pain may exacerbate with lumbar extension or rotation and radiate to the posterior thigh.
Thoracic Facet Joint Interventions
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Laxmaiah Manchikanti, David M. Schultz, Vijay Singh
In a nonrandomized prospective trial, Stolker et al.8 evaluated the effectiveness of percutaneous facet denervation in chronic thoracic spinal pain. They evaluated 40 patients with chronic thoracic spinal pain of greater than 12 months’ duration, which failed to respond to conservative treatment. All patients were evaluated by specialists, mainly neurologists and orthopedic surgeons. The diagnosis of facet syndrome was made by clinical criteria and a transient positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. The results showed that 40 patients underwent 51 percutaneous thoracic facet denervations. After 2 months, 19 patients (47.5%) were pain free and 14 patients (35%) had more than 50% pain relief, with a total of 82.5% of the patients reporting greater than 50% relief. With a long-term follow-up average of 31 months in 36 patients, 44% were pain free and 39% had more than 50% pain relief, with a total of 83% of the patients presenting greater than 50% relief.
Low Back Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
Lumbar facet syndrome is a dysfunction at the posterior facet joint of the spine. The term “dysfunction” means that the lumbar facet joints are not functioning normally. Because the facet joints together with the disc form the intervertebral joint, changes to the anatomic structure at the posterior facet joints can influence the intervertebral disc, resulting in low back pain. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain; loss of joint space, narrowing, loss of synovial fluid, and loss of cartilage and bony overgrowth are the common changes due to osteoarthritis. The most common cause is repetitive microtrauma. In daily living, work, and sports that involve repetitive excessive hyperextension or arching of the lumbar spine, or excessive hyperextension with rotation of the back, swelling of tissues from the surrounding structures of facet joints arising from local inflammation caused by the repetitive microtrauma irritates the nerve roots, resulting in pain.Overloading to the facet joints may damage the intervertebral disc and change the biomechanics of the joint.Physical trauma to the lumbar region may tear the capsule, leading to a subluxation of the facet joint.A hypertonic contraction of the surrounding muscles may occur due to a self-protection mechanism, resulting in fibrosis and osteophyte formation or spur.
Use of lasers in minimally invasive spine surgery
Published in Expert Review of Medical Devices, 2018
Facet syndrome or facet joint arthritis is one of the major etiologies of low back pain for which surgical intervention might be applied [55,56]. Lumbar facets or zygapophyseal joints are synovial arthroses richly innervated with nerve endings from the medial branch of the posterior primary ramus [57]. Current treatment options include facet joint block or medial branch block for short-term pain relief and facet joint denervation for long-term pain relief by radiofrequency or cryotherapy. The results of facet joint denervation or rhizotomy have been variable, with many patients requiring repeated procedures or experiencing inadequate pain relief. Some authors have reported laser facet denervation techniques [56,58,59]. The patient is placed prone on the radiolucent table. Under fluoroscopic guidance or endoscopic visualization, the Ho:YAG straight-firing laser probe is directed at the medial branch or the dorsal ramus, the nerve that gives rise to the articular branches at each level. Each facet joint is innervated from above and below the segments. The laser probe can be also directed to the facet joint itself. The target points are the lower, middle, and upper portions of the facet joint. The total irradiation energy at one facet is about 500–600 J. Laser has the advantage of coagulating a relatively larger area in the vicinity of the probe tip compared with a radiofrequency probe. Laser facet denervation can be applicable and efficient for patients who failed to be relieved by block or radiofrequency facet rhizotomy.