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.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.
"If greater visualization is necessary, a portion of the inferior spinous process can be removed. Patients have been shown to have similar outcomes in these procedures if not better than those of the traditional open techniques6263646566. For thoracic disc resection, thoracoscopy nor thoracotomy is necessarily required, especially for soft discs [67, 68]. "
[Show abstract][Hide abstract]ABSTRACT: Minimally invasive spine surgery has its roots in the mid-twentieth century with a few surgeons and a few techniques, but it has now developed into a large field of progressive spinal surgery. A wide range of techniques are now called "minimally invasive," and case reports are submitted constantly with new " minimally invasive" approaches to spinal pathology. As minimally invasive spine surgery has become more mainstream over the past ten years, in this paper we discuss its history and development.
Full-text · Article · May 2014 · BioMed Research International
"Datta et al.  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  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 . "
"Datta et al.  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  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 . "
[Show abstract][Hide abstract]ABSTRACT: To determine whether data obtained from patients returning postal questionnaires accurately reflect how patients receiving imaging-guided lumbar facet injections respond.
Seventy-eight patients receiving lumbar facet joint injections who returned an outcomes questionnaire (responders) were age and gender matched with 78 patients who did not return the postal questionnaire (non-responders) after facet joint injections. Baseline numerical rating scale (NRS) pain data were collected. NRS and Patients' Global Impression of Change (PGIC) data were collected 1 month after injection by postal questionnaire or telephone interview. Differences in NRS scores were calculated using the unpaired t-test. One level injection patients were compared to patients having ≥2 levels injected using the paired and unpaired t-test. The proportion of patients reporting significant improvement in each group was calculated.
NRS scores were significantly improved compared to baseline (p = 0.0001). Thirty-eight percent of responders were significantly improved compared to 50 % of non-responders. Patients having ≥2 levels injected reported significantly higher baseline NRS scores, but by 1 month there was no difference in NRS scores between groups.
Patients returning postal questionnaires report a less favourable outcome. Telephone interview patients having injections at more than one level have better outcomes. MAIN MESSAGES : • Patients returning postal questionnaires report worse outcomes after facet injection. • Method of data collection should be considered when reporting treatment outcomes. • Patients receiving facet injections at more than one level report greater levels of pain reduction.
Full-text · Article · Jun 2012 · Insights into Imaging