Expert Commentary

MRI Analysis of the Lumbar Spine: Can It Predict Response to Diagnostic and Therapeutic Facet Procedures?

Milan P. Stojanovic, MD

Department of Anesthesia and Critical Care
MGH Center for Pain Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts

Current diagnostic techniques often fail to identify pain generators in patients with low back pain. For example, although chronic low back pain commonly results from facet joint arthropathy, it is difficult to identify a painful facet joint via patient history, physical examination, and radiologic imaging. Therefore, a diagnosis of facet pain is usually based on reports of analgesia in response to blocks of the medial branches innervating the joints, although this approach too can be unreliable. Methods are needed to minimize misdiagnosis and identify patients most likely to respond facet-directed therapies, including radiofrequency (RF) denervation, a procedure that can provide pain relief for up to several years. Here Stojanovic and collogues examined correlations between magnetic resonance imaging (MRI) findings and the results of facet joint nerve blocks and RF denervation. Interestingly, patients with spinal stenosis were significantly more likely to benefit from RF denervation of the affected facet joints. No significant correlation was found between a loss of disk height and outcomes from a facet joint intervention, however. The results of this study suggest that patients with MRI evidence of spinal stenosis—often considered an exclusion criterion for facet interventions—may benefit from RF denervation of facet joints.

References

  1. Stojanovic MP, Sethee J, Mohiuddin M, et al. MRI analysis of the lumbar spine: can it predict response to diagnostic and therapeutic facet procedures? Clin J Pain. 2010;26(2):110-115.
  2. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591-614.
  3. Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007;23(1):45-52.
  4. Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain. 1997;13(4):285-302.
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