Article

Minimal invasive therapeutic interventional procedures in the spine: an evidence-based review. Surg Technol Int

Scientific Committee, Back Care Network, Athens, Greece.
Surgical technology international 02/2008; 17:259-68.
Source: PubMed

ABSTRACT

This chapter evaluates the current evidence on common minimally invasive therapeutic spinal procedures based on the Levels of Evidence and Grades of Recommendation developed by the Centre for Evidence-Based Medicine (Oxford, United Kingdom). The results of the evaluation of current clinical evidence allow the following recommendations to be made: epidural adhesiolysis performed repeatedly every 3 months to 4 months is effective in the "post lumbar laminectomy" syndrome; epidural steroid injections may provide only short-term relief from pain in lumbar radiculopathy but have no long-term effect; selective nerve root injections of corticosteroids have no therapeutic effect on the long-term natural history of radiculopathy symptoms; intra-articular facet joint injections of corticosteroids have no therapeutic effect on lower back pain (grade of recommendation: A). Furthermore, percutaneous vertebroplasty and balloon kyphoplasty provide immediate pain relief from osteoporotic spinal fractures but no significant long-lasting benefit (grade of recommendation: B). Finally, there is limited evidence (grade of recommendation: C) of the value of medial branch (facet) neurotomy, sacroiliac joint injection of steroids, and intradiscal electrothermal therapy, as well as of the advantages of percutaneous endoscopic lumbar discectomy over open microdiscectomy. As the level of evidence is generally low, more prospective randomized-controlled studies are needed to establish the value of the considered methods.

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    • "Datta et al. [10] concluded that although there is strong evidence for the diagnostic accuracy of facet joint blocks in evaluating spinal pain, the evidence for therapeutic lumbar intraarticular injections is level III (limited). Furthermore, an earlier study [11] found that intra-articular facet joint injections containing corticosteroids seemed to have no additional therapeutic effect on lower back pain compared to injections of anesthetic alone. It has even been suggested that intraarticular facet joint injections may be no better than placebo for chronic lumbar spine pain [12]. "
    Preview · Article · Jan 2013
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    • "Datta et al. [10] concluded that although there is strong evidence for the diagnostic accuracy of facet joint blocks in evaluating spinal pain, the evidence for therapeutic lumbar intraarticular injections is level III (limited). Furthermore, an earlier study [11] found that intra-articular facet joint injections containing corticosteroids seemed to have no additional therapeutic effect on lower back pain compared to injections of anesthetic alone. It has even been suggested that intra-articular facet joint injections may be no better than placebo for chronic lumbar spine pain [12]. "
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