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Not All Conditions Respond Equally to Spine Injections: A Review of the Outcome Literature for Common Spine Pathologies

  • Interventional Pain Management (DJ Kennedy, Section Editor)
  • Published:
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Abstract

A variety of spinal pathologies can result in symptoms including low back and radicular pain. These different diagnostic etiologies have different natural histories and may have varying responses to treatment. Unfortunately, this is not often accounted for in the literature, and the outcomes from treatment of these various diseases are lumped together based on their symptomology. This is an inappropriate way to examine the literature given the different pathologies. This article will therefore offer a narrative review of the outcomes of injection therapy for common disease processes including zygapophyseal (facet) joint pain, sacroiliac joint pain, discogenic pain, disk herniation with radicular pain, and spinal stenosis.

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References

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  1. Li J, Muehleman C, Abe Y, et al. Prevalence of facet joint degeneration in association with intervertebral joint degeneration in a sample of organ donors. J Orthop Res. 2011;29(8):1267–74.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yong-Hing K, Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am. 1983;14(3):491–504.

    Article  CAS  PubMed  Google Scholar 

  3. Nachemson A. The future of low back pain. In: Weinstein JN, Wiesel SW, editors. The lumbar spine. The International Society for the Study of the Lumbar Spine, vol. 15. Philadelphia: WB Saunders; 1990. p. 458–61.

    Google Scholar 

  4. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363–70.

    Article  CAS  PubMed  Google Scholar 

  5. Huston C, McCowen A. Etiologies of painful spinal disorders. In: DePalma, M, editor. iSpine: evidence-based interventional spine care. New York: Demos Medical; 2011. p. 1.

    Google Scholar 

  6. Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Muskuloskelet Disord. 2004;5:15.

    Article  Google Scholar 

  7. Manchukonda R, Manchikanti KN, Cash KA, Pampati V, Manchikanti L. Facet joint pain in chronic spinal pain: an evaluation of prevalence and false positive rate of diagnostic blocks. Pain Phys. 2007;10:20–1.

    Google Scholar 

  8. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19:1132–7.

    Article  CAS  PubMed  Google Scholar 

  9. Revel M, Poiraudeau S, Auleley GR, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine. 1998;23:1972–7.

    Article  CAS  PubMed  Google Scholar 

  10. Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine. 1984;9:746–50.

    Article  CAS  PubMed  Google Scholar 

  11. Helbig T, Lee CK. The lumbar facet syndrome. Spine. 1988;13:61–4.

    Article  CAS  PubMed  Google Scholar 

  12. Jackson RP, Jacobs RR, Montesano PX. Facet joint injection in low back pain. A prospective study. Spine. 1988;13:966–71.

    Article  CAS  PubMed  Google Scholar 

  13. Schwarzer AC, Derby R, Aprill CN, et al. Pain from the lumbar zygapophysial joints: a test of two models. J Spinal Disord. 1994;7(4):331–6.

    Article  CAS  PubMed  Google Scholar 

  14. Fairbank JC, Park WM, McCall IW, et al. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine. 1981;6:598–605.

    Article  CAS  PubMed  Google Scholar 

  15. Lewinnek GE, Warfield CA. Facet joint degeneration as a cause of low back pain. Clin Orthop. 1986;213:216–22.

    Article  Google Scholar 

  16. Dreyer SJ, Dreyfuss PH. Low back pain and the zygapophysial joints. Arch Phys Med Rehabil. 1996;77:290–300.

    Article  CAS  PubMed  Google Scholar 

  17. Boswell Mark V, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Phys. 2007;10:7–111.

    Google Scholar 

  18. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106:591–614.

    Article  PubMed  Google Scholar 

  19. Fairbank JC, Park WM, McCall IW, O’Brien JP. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine (Phila Pa 1976). 1981;6:598–605.

    Article  CAS  Google Scholar 

  20. Lilius G, Laasonen EM, Myllynen P, Harilainen A, Salo L. Lumbar facet joint syndrome. Significance of non-organic signs. A randomized placebo-controlled clinical study. Rev Chir Orthop Reparatrice Appar Mot. 1989;75:493–500.

    CAS  PubMed  Google Scholar 

  21. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, Latulippe M. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. 1991;325:1002–7.

    Article  CAS  PubMed  Google Scholar 

  22. Lakemeier S, Lind M, Schultz W, Fuchs-Winkelmann S, Timmesfeld N, Foelsch C, Peterlein CD. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg. 2013;117(1):228–35.

    Article  CAS  PubMed  Google Scholar 

  23. Manchikanti L, Helm S, Singh V, et al. An algorithm approach for clinical management of chronic spinal pain. Pain Phys. 2009;12(4):E225–64.

    Article  Google Scholar 

  24. Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence based knee injections for the management of arthritis. Pain Med. 2012;13:740–53.

    Article  PubMed  Google Scholar 

  25. Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011;70:110–6.

    Article  PubMed  Google Scholar 

  26. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25(10):1270–7.

    Article  CAS  PubMed  Google Scholar 

  27. Gofeld M, Jitendra J, Faclier G. Radiofrequency denervation of the lumbar zygapophysial joints: 10-year prospective clinical audit. Pain Phys. 2007;10(2):291–300.

    Article  Google Scholar 

  28. • Macvicar J, Borowczyk JM, Macvicar AM, Loughnan BM, Bogduk N. Lumbar medial branch radiofrequency neurotomy in New Zealand. Pain Med Malden Mass. 2012. doi: 10.1111/pme.12000. Lumbar Radiofrequency neurotomy can be very effective when performed in a rigorous manner in appropriately selected patients. Chronic back pain, mediated by the lumbar medial branches, can be stopped and patients fully restored to normal living, if treated with neurotomy.

    Article  PubMed  Google Scholar 

  29. • MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med Malden Mass. 2012;13:647–54. Cervical Radiofrequency neurotomy can be very effective when performed in a rigorous manner in appropriately selected patients. Chronic neck pain, mediated by the cervical medial branches, can be temporarily, but completely, relieved and patients fully restored to desired activities of daily living, if treated with neurotomy.

    Article  PubMed  Google Scholar 

  30. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995;20:31–7.

    Article  CAS  PubMed  Google Scholar 

  31. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998;79:288–92.

    Article  CAS  PubMed  Google Scholar 

  32. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain [comment]. Spine. 1996;21:2594–602.

    Article  CAS  PubMed  Google Scholar 

  33. Chou LH, Slipman CW, Bhagia SM, Tsaur L, Bhat AL, Isaac Z, Gilchrist R, El Abd OH, Lenrow DA. Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med. 2004;5(1):26–32.

    Article  PubMed  Google Scholar 

  34. Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334–8.

    Article  CAS  PubMed  Google Scholar 

  35. Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: asymptomatic volunteers. Spine. 1994;19:1475–82.

    Article  CAS  PubMed  Google Scholar 

  36. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic ET. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998;79(3):288–92.

    Article  CAS  PubMed  Google Scholar 

  37. LeBlanc KE. Sacroiliac sprain: an overlooked cause of back pain [comment]. Am Fam Phys. 1992;46:1459–63.

    CAS  Google Scholar 

  38. Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Braverman DL. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil. 2001;80(6):425–32.

    Article  CAS  PubMed  Google Scholar 

  39. Liliang PC, Lu K, Weng HC, Liang CL, Tsai YD, Chen HJ. The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine. 2009;34(9):896–900.

    Article  PubMed  Google Scholar 

  40. Bogduk N. Epidural steroid for low back pain and sciatica: executive summary and recommendations of the working party of the national health and medical research council. Pain Digest. 1999;9:226–34.

    Google Scholar 

  41. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine. 1995;20(17):1878–83.

    Article  CAS  PubMed  Google Scholar 

  42. Manchikanti L, Singh V, Rivera JJ, Pampati V, Beyer C, Damron K, Barnhill RC. Effectiveness of caudal epidural injections in discogram positive and negative chronic low back pain. Pain Phys. 2002;5(1):18–29.

    Article  Google Scholar 

  43. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. 2004;4(5):495–505.

    Article  PubMed  Google Scholar 

  44. Lee JH, An JH, Lee SH. Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis. Clin J Pain. 2009;25(3):206–10.

    Article  PubMed  Google Scholar 

  45. Anderson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581–5.

    Article  Google Scholar 

  46. •• MacVicar J, King W, Landers MH, Bogduk N. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med Malden Mass 2013;14:14–28. It shows that patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery.

    Article  PubMed  Google Scholar 

  47. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med Malden Mass. 2010;11:1149–68.

    Article  Google Scholar 

  48. Ghahreman A, Bogduk N. Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation. Pain Med Malden Mass. 2011;12:871–9.

    Article  Google Scholar 

  49. Vad VB, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002;27:11–6.

    Article  PubMed  Google Scholar 

  50. Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000;82:1589–93.

    Article  CAS  PubMed  Google Scholar 

  51. Simotas AC, Dorey FJ, Hansraj KK, Cammisa F, Katz JN. Nonoperative treatment for lumbar spine stenosis: clinical and outcome results and a 3-year survivorship analysis. Spine. 2000;25:197–208.

    Article  CAS  PubMed  Google Scholar 

  52. Atlas SJ, Deyo RA, Keller RB, et al. The Maine Lumbar Spine Study, part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine. 1996;21:1787–94 discussion 1794-5.

    Article  CAS  PubMed  Google Scholar 

  53. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study. Spine. 2000;25:556–62.

    Article  CAS  PubMed  Google Scholar 

  54. Delport EG, Cucuzzella AR, Marley JK, Pruitt CM, Fisher JR. Treatment of lumbar spinal stenosis with epidural steroid injections: a retrospective outcome study. Arch Phys Med Rehabil. 2004;85(3):479–84.

    Article  PubMed  Google Scholar 

  55. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial. Spine. 2010;35(14):1329–38.

    Article  PubMed  PubMed Central  Google Scholar 

  56. •• Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, Bauer Z, Bresnahan BW, Avins AL, Nedeljkovic SS, Nerenz DR, Standaert C, Kessler L, Akuthota V, Annaswamy T, Chen A, Diehn F, Firtch W, Gerges FJ, Gilligan C, Goldberg H, Kennedy DJ, Mandel S, Tyburski M, Sanders W, Sibell D, Smuck M, Wasan A, Won L, Jarvik JG. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;3;371(1):11–21. Concludes that for treating lumbar spinal stenosis, epidural injection of glucocorticoids along with lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone.

    Article  CAS  Google Scholar 

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  1. Department of Physical Medicine & Rehabilitation, University of Miami, Miller School of Medicine, Miami, USA

    Jose Mena & Andrew Sherman

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Correspondence to Jose Mena.

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This article is part of the Topical Collection on Interventional Pain Management.

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Mena, J., Sherman, A. Not All Conditions Respond Equally to Spine Injections: A Review of the Outcome Literature for Common Spine Pathologies. Curr Phys Med Rehabil Rep 3, 135–141 (2015). https://doi.org/10.1007/s40141-015-0083-4

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