Abstract
Lumbar facet joint pain cannot be reliably diagnosed clinically, the International Spinal Injection Society recommends two diagnostic local anaesthetic blocks before radiofrequency (RF) denervation [1].
Scoring systems may improve diagnostic accuracy. The two most popular scores disagree on the interpretation of pain induced by extension/rotation:
‘Cochin Criteria’ [2]: pain on extension/rotation _ not facet joint problem
Helbig & Lee [3]: pain on extension/rotation _ facet joint problem
Methods: Retrospective study of all patients who had RF denervations of the lumbar facet joints in 2004.
Patients were selected clinically and did not undergo diagnostic blocks.
Cochin criteria, Helbig & Lee scores, work status, and outcome were taken from the case notes.
Likelihood ratios were calculated for the scores, their individual components, and work status.
Results: 145 patients underwent RF facet joint denervation, for 127 all data was available. In 68 patients the procedure was successful (53.5%).
Conclusion: Neither the Cochin Criteria nor the Helbig & Lee score can predict the response to radiofrequency denervation of the lumbar facet joints.
Pain on extension/rotation weakly indicates a poor response to facet joint denervation.
X-rays do not help with the diagnosis.
Social factors may be more important than clinical signs.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
References:
[1] N Bogduk. International Spinal Injection Society Guidelines for the Performance of Spinal Injection Procedures. Part 1: Zygapophysial Joint Blocks. Clin J Pain13 (4) 1997, 285 – 286 Google Scholar
[2] M Revel, S Poiraudeau, GR Auleley, C Payan, A Denke, M Nguyen, A Chevrot, and J Fermanian. Capacity of the Clinical Picture to Characterize Low Back Pain Relieved by Facet Joint Anesthesia: Proposed Criteria to Identify Patients with Painful Facet Joints. Spine, 23 (18), 1998, 1972 – 1976 Google Scholar
[3] T Helbig and CK Lee. The lumbar facet syndrome. Spine, 13 (1), 1988, 61 – 64 Google Scholar
