The Ability of Computed Tomography to Identify a Painful Zygapophysial Joint in Patients With Chronic Low Back Pain

Faculty of Medicine, University of Newcastle, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Spine (Impact Factor: 2.3). 05/1995; 20(8):907-12. DOI: 10.1097/00007632-199504150-00005
Source: PubMed


A prospective cross-sectional analytic study.
To assess in patients with chronic low back pain whether the presence or absence of pain originating from the lumbar zygapophysial joints correlates with changes seen on computed tomography.
Results of studies have been divided as to whether or not radiologic imaging is able to predict those patients with pain originating from the zygapophysial joints.
Sixty-three patients with low back pain lasting for longer than 3 months underwent computed tomography and blocks of the zygapophysial joints at L5-S1, L4-L5, and L3-L4. The zygapophysial joints of all images were scored by three independent, masked radiologists.
Interobserver agreement was poor with intraclass correlation coefficients of 0.34-0.66 using total joint scores for all three assessors. Using the results of a repeat assessment with two radiologists there was no statistically significant difference in joint scores between those with and those without pain originating from the zygapophysial joint.
Computed tomography has no place in the diagnosis of lumbar zygapophysial joint pain.

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    • "Facet joint disturbances can be responsible for 10% to 50% of all cases of chronic lumbar pain (5-8). However, clinical history or physical examination cannot identify facet joint alterations as the origin of pain (7,9-13), nor does imaging (e.g., radiography, computed tomography [CT] or magnetic resonance imaging [MRI]) (7,14-16). The only tool to identify facet joint alterations as the cause of pain is the verification of an analgesic response to anesthetic injections into the zygapophyseal joints or at their nerve supplies (17-20) and medial dorsal branch blocks are easier to perform (21). "
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    ABSTRACT: OBJECTIVES: To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS: Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS: A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05). CONCLUSION: Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.
    Full-text · Article · Aug 2014 · Clinics (São Paulo, Brazil)
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    • "Some disagreement exists on the ability of radiologic imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), to diagnose facet joint disease and predict its response to diagnostic nerve blocks [2,6-8]. However some studies have reported that bone scintigraphy with single photon emission computed tomography (SPECT) has a high sensitivity and specificity in diagnosing facet joint disease [9-11]. "
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    ABSTRACT: Facet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block. SPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results. Of the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen. SPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.
    Full-text · Article · Jun 2011 · The Korean journal of pain
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    • "In patients with acute trauma, CT may be better in visualizing fractures, especially of the posterior elements [1]. CT is also more reliable than MRI for detecting facet degenerative changes, because of the same reason [16]. Both CT and MRI are useful in evaluating vertebral compression fracture. "
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    ABSTRACT: In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4-6 weeks. The natural history of low back pain is favorable with improvement over time, thus reassurance to such patients is very important. However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits. There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.
    Preview · Article · Jul 2009 · Current Reviews in Musculoskeletal Medicine
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