Does neural blockade and other neurosurgical modalities offer a durable pain relief for spinal disorders?

• Published in: Best practice & research. Clinical rheumatology 2002-01, Vol.16 (1), p.155-164
• Main Author: Rosenow, Detlef E.
• Format: Article
• Language: English
• Subjects: Back Pain - etiology; Back Pain - surgery; facet joint syndrome; Humans; Nerve Block; Neurosurgical Procedures; percutaneous denervating techniques; spinal canal stenosis; Spinal Diseases - complications; Spinal Diseases - surgery; Time Factors
• ISSN: 1521-6942; 1532-1770
• DOI: 10.1053/berh.2002.0206

Various minimally invasive techniques have been performed to fight pain originating at bony and soft tissue spine elements. Of these, denervation of the nerve supply to the facet joints is the only technique for which three multidisciplinary clinical studies have been conducted, according to state-of-the-art study criteria, to produce evidence-based efficacy data. Of all of the morphopathological factors contributing to chronic spinal pain, facet joints play a major role in generating spinal pain due to hypermobility or joint degeneration. This is commonly referred to as facet joint syndrome (FJS). Other important non-morphological co-morbidity factors (mostly psychiatric, social or occupational in origin) also play an important role in mediating spinal pain. From the existing evidence-based data, there seems to be nodurable pain relief in FJS using standard lesioning techniques (thermal and/or cryo). Efficacy compared to placebo lasts for only 4 weeks. Only those patients with spinal canal stenosis and concomitant chronic FJS appear to benefit after microsurgical decompression of the narrowed spinal canal. However, the database for this claim is low since low back pain is not the major focus in the clinical symptoms reported by the patients.