Article

Zygapophysial joint blocks in chronic low back pain: a test of Revel's model as a screening test

Department of Health and Society: Physiotherapy, Faculty of Health Sciences, Linköpings Universitet, SE-581581-85, Sweden.
BMC Musculoskeletal Disorders (Impact Factor: 1.9). 11/2004; 5:43. DOI: 10.1186/1471-2474-5-43
Source: PubMed

ABSTRACT Only controlled blocks are capable of confirming the zygapophysial joints (ZJ) as the pain generator in LBP patients. However, previous workers have found that a cluster of clinical signs ("Revel's criteria"), may be valuable in predicting the results of an initial screening ZJ block. It was suggested that these clinical findings are unsuitable for diagnosis, but may be of value in selecting patients for diagnostic blocks of the lumbar ZJ's. To constitute evidence in favour of a clinical management strategy, these results need confirmation. This study evaluates the utility of 'Revel's criteria' as a screening tool for selection of chronic low back pain patients for controlled ZJ diagnostic blocks.
This study utilized a prospective blinded concurrent reference standard related validity design. Consecutive chronic LBP patients completed pain drawings, psychosocial distress and disability questionnaires, received a clinical examination and lumbar zygapophysial blocks. Two reference standards were evaluated simultaneously: 1. 75% reduction of pain on a visual analogue scale (replication of previous work), and 2. abolition of the dominant or primary pain. Using "Revel's criteria" as predictors, logistic regression analyses were used to test the model. Estimates of sensitivity, specificity, predictive values and likelihood ratios for selected variables were calculated for the two proposed clinical strategies.
Earlier results were not replicated. Sensitivity of "Revel's criteria" was low sensitivity (<17%), and specificity high (approximately 90%). Absence of pain with cough or sneeze just reached significance (p = 0.05) within one model.
"Revel's criteria" are unsuitable as a clinical screening test to select chronic LBP patients for initial ZJ blocks. However, the criteria may have use in identifying a small subset (11%) of patients likely to respond to the initial block (specificity 93%).

0 Followers
 · 
166 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective : The aim of this study is to evaluate the clinical results of endoscopic radiofrequency ablation of medial branch in patients with chronic low back pain originating from facet joints. Methods : Between October 201 0 and December 2013, 52 consecutive patients had suffering from chronic low back pain had undergone endoscopic radiofrequency denervation of medial branch of dorsal ramus. The clinical outcomes of these 52 patients were reviewed retrospectively. Preoperative and postoperative Visual Analogue Scale (VAS) and Korean version of Oswestry Disability Index (K-OD 1), and patients' satisfaction with the procedure were assessed. Results : The pain scores on the VAS for back pain had improved significantly from a preoperative mean of 7.1 to a postoperative mean of 2 at the last follow-up (p<0.001). The clinical outcomes based on the K-ODI had also improved significantly from a preoperative mean of 26.5% to postoperative mean of 7.7% at the last follow-up (p<0.001). 80% of patients were satisfied with the procedure. There were no complications associated with the procedure. Conclusion : Our preliminary results demonstrate that endoscopic radiofrequency denervation of medial branch could be an effective alternative treatment modality for chronic back pain originating from facet joints that provides long-term pain relief.
    Journal of Korean Neurosurgical Society 10/2014; 56(4):338-43. DOI:10.3340/jkns.2014.56.4.338 · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this review was to evaluate the existing literature regarding the accuracy of the Kemp's test in the diagnosis of facet joint pain compared to a reference standard.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To provide a review of the medical literature and practical experience in the diagnosis, history, and physical examination of the spine with emphasis on the administration of spinal injections and their role in the treatment of painful spinal conditions.
    Operative Techniques in Sports Medicine 06/2012; 20(2):154–171. DOI:10.1053/j.otsm.2012.04.003 · 0.21 Impact Factor

Full-text (4 Sources)

Download
121 Downloads
Available from
May 29, 2014