The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain
| Autor: | Blake Johnson, Charles Aprill, Paul Dreyfuss, Steve Pollei, Alison Stout, Nikolai Bogduk |
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| Rok vydání: | 2009 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Physical Therapy Sports Therapy and Rehabilitation Lumbar vertebrae Zygapophyseal Joint Multifidus muscle Muscular Atrophy Spinal Lumbar Atrophy Predictive Value of Tests Pain assessment medicine Humans Prospective Studies Denervation Lumbar Vertebrae medicine.diagnostic_test business.industry Rehabilitation Reproducibility of Results Magnetic resonance imaging medicine.disease Magnetic Resonance Imaging Low back pain Surgery Treatment Outcome medicine.anatomical_structure Neurology Neurology (clinical) medicine.symptom business Low Back Pain Follow-Up Studies |
| Zdroj: | PM&R. 1:719-722 |
| ISSN: | 1934-1482 |
| Popis: | Objective To determine the presence of lumbar multifidus atrophy and pain after successful lumbar medial branch radiofrequency neurotomy for zygapophysial joint mediated pain. Design A prospective observational analysis of 5 patients who had undergone successful unilateral radiofrequency neurotomy (RFN) of the lumbar medial branch divisions of the lumbar dorsal rami. At 17 to 26 months after RFN, 3 blinded radiologists evaluated the relative composition and size of the multifidus muscle at different segmental levels on lumbar magnetic resonance imaging (MRI). They were asked to determine the lesioned levels by evidence of multifidus atrophy. The accuracy of predicting the correct side and level lesioned was evaluated. Setting Private spine practice in Tyler, Texas. Patients Five patients who had unilateral lumbar medial branch RFN for proven lumbar zygapophysial joint-mediated pain were selected. Interventions MRI of the lumbar spine at a mean of 21 months (range, 17-26) after successful lumbar RFN. Outcome Measures Multifidus atrophy on a lumbar MRI, pain assessment and use of cointerventions. Results Diffuse lumbar multifidus atrophy was detectable with MRI. However, radiologists could not reliably predict the side and segments lesioned. Despite denervation of the multifidus, at 12 months after RFN all subjects had ongoing pain relief and did not require or request additional treatment. Conclusions This preliminary study provides evidence that successful medial branch RFN for lumbar zygapophysial-mediated pain does cause initial denervation but no discernable segmental atrophy of the multifidus at long-term follow-up. Previous denervation and diffuse atrophy in these subjects was not associated with pain. |
| Databáze: | OpenAIRE |
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