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Multimodal treatment including lumbar facet joint denervation for severe low back pain in patients with neuromuscular disorders

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Abstract

Background

Severe low back pain (LBP) is an occasional complaint in patients with neuromuscular disorders (NMDs). Accurate diagnosis and treatment are required to manage LBP; however, the precise pathophysiology differs for each patient. This study aimed to evaluate the efficacy of lumbar facet joint denervation (FJD) and adjunctive modalities in the treatment of LBP in patients with NMD-associated kyphoscoliosis.

Methods

A total of 16 patients (22 sites) with NMD (bilateral, n = 6; unilateral, n = 10) and LBP treated with lumbar FJD were evaluated. The patients were divided into two groups: those treated with FJD alone (group 1) and those treated with multimodal treatment, including FJD along with radiofrequency ablation for sacroiliac joint pain, piriform muscle block, botulinum toxin injection into the paraspinal muscles, spinal cord stimulation, or any of their combinations (group 2). All patients were followed up for 48 weeks postoperatively. The two groups were compared with respect to the duration required for improvements in LBP by more than 50% (numerical rating scale ≤ 5).

Results

There was no significant difference between the groups regarding the age, duration since the onset of Parkinson’s syndrome, and radiographic analysis. The effective period of improved pain was greater in group 2 than in group 1 (30.7 vs. 8.4 weeks, P < 0.01).

Conclusions

Multimodal treatment including FJD is safe and relatively effective in patients with NMD-associated kyphoscoliosis. Hence, it is a potential substitute for conventional spinal fixation surgery, which has a higher risk of complications.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The authors thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, Japan

    Tohru Terao, Naoki Kato, Yuichi Sasaki, Keiichirou Ohara, Shoutarou Michishita & Yosuke Nakayama

  2. Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Keisuke Hadano, Kostadin Karagiozov, Satoshi Tani & Yuichi Murayama

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  1. Tohru Terao
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Tohru Terao, Naoki Kato, Kostadin Karagiozov, Keisuke Hadano, and Satoshi Tani. The first draft of the manuscript was written by Tohru Terao, Kostadin Karagiozov, and Satoshi Tani and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tohru Terao.

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Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local ethics committee of Atsugi City Hospital (approval number R1-06).

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Informed consent was obtained from all participants included in the study.

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Terao, T., Kato, N., Sasaki, Y. et al. Multimodal treatment including lumbar facet joint denervation for severe low back pain in patients with neuromuscular disorders. Neurol Sci 43, 593–601 (2022). https://doi.org/10.1007/s10072-021-05298-9

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