Open AccessA Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain
Author(s) -
Mark V. Boswell,
Laxmaiah Manchikanti,
Alan D. Kaye,
Sanjay Bakshi,
Christopher Gharibo,
Sanjeeva Gupta,
Sachin Sunny Jha,
Devi E. Nampiaparampil,
Thomas Simopoulos,
Joshua A Hirsch
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/e497
Subject(s) - medicine , facet joint , facet (psychology) , physical therapy , meta analysis , low back pain , spinal manipulation , lumbar , nerve block , local anesthetic , critical appraisal , evidence based medicine , back pain , chronic pain , surgery , pathology , alternative medicine , psychology , social psychology , personality , big five personality traits
Background: Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referredpain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities areunreliable in diagnosing zygapophysial joint pain.Study Design: A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks.Objective: To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain.Methods: A methodological quality assessment of included studies was performed using QualityAppraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of thedesignated inclusion criteria were utilized for analysis.The level of evidence was classified as Level I to V based on the grading of evidence utilizing bestevidence synthesis.Data sources included relevant literature identified through searches of PubMed and other electronicsearches published from 1966 through March 2015, Cochrane reviews, and manual searches of thebibliographies of known primary and review articles.Outcome Measures: Studies must have been performed utilizing controlled local anestheticblocks. The criterion standard must have been at least 50% pain relief from baseline scores and theability to perform previously painful movements.Results: The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion ofa total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an averageprevalence of 16% to 41% and false-positive rates of 25% to 44%.The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II basedon a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalencein a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%.The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II with80% or higher pain relief as the criterion standard with a prevalence ranging from 34% to 48% andfalse-positive rates ranging from 42% to 48%.Limitations: The shortcomings of this systematic review include a paucity of literature related tothe thoracic spine, continued debate on an appropriate gold standard, appropriateness of diagnosticblocks, and utility.Conclusion: The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks,Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks inassessment of chronic spinal pain.Key words: Chronic spinal pain, lumbar facet or zygapophysial joint pain, cervical facet orzygapophysial joint pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medialbranch blocks, controlled comparative local anesthetic blocks