OBJECTIVE: Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity. METHODS: In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations. RESULTS: Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications. CONCLUSIONS: This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions.
- MeSH
- bederní obratle diagnostické zobrazování MeSH
- chronická bolest diagnostické zobrazování etiologie MeSH
- degenerace meziobratlové ploténky * diagnostické zobrazování komplikace MeSH
- dospělí MeSH
- jednofotonová emisní výpočetní tomografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování etiologie MeSH
- magnetická rezonanční tomografie * metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- SPECT/CT metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION AND PURPOSE: With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). MATERIAL AND METHODS: This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. RESULTS: During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. CONCLUSION: Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04876586.
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- degenerace meziobratlové ploténky * diagnostické zobrazování chirurgie MeSH
- fúze páteře * metody MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování etiologie chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Ultrasound (US) has been widely used for the diagnosis and guided interventions of peripheral nerve disorders. Although superior cluneal nerve (SCN) entrapment is an important cause of lower back pain, a relevant review as to how US can be used for imaging and guided intervention for cases of SCN entrapment is still lacking. OBJECTIVES: This review aims to revisit the anatomy and pertinent clinical issues of SCN entrapment, as well as the role of US regarding the diagnosis and subsequent management of relevant clinical scenarios. STUDY DESIGN: A narrative review. METHODS: Although the present article is a narrative review, we used a systematic approach to search the relevant literature. The combinations of key words, including SCN, ultrasound, and sonography, were used to search PubMed and Medline without restriction of languages or article types. The search period was from the earliest record through November 2021. RESULTS: Our included studies showed that high-resolution US and knowledge of sonoanatomy facilitated the visualization of individual branches of the SCN after emerging from the erector spinae muscles. However, the diagnostic block was needed for confirmation of SCN entrapment. Perineural US-guided injection was helpful in relieving the complaints of SCN entrapment; whereas, hydrodissection underneath the thoracolumbar fascia over the iliac crest seems to be a feasible approach for postsurgical analgesia. LIMITATIONS: There was no clinical trial comparing the efficacy of different injection techniques and regimens. CONCLUSIONS: US imaging is helpful for guiding injections of SCN entrapment and related clinical conditions. The evidence of US imaging in diagnosing SCN disorders remains insufficient, which requires more prospective studies to validate.
The aim of this observational, cross-sectional study was to analyse lumbar magnetic resonance imaging (MRI) findings in patients with non-specific chronic low back pain (CLBP), and to evaluate any correlation with pain intensity and their capacity to predict neuropathic pain (NP) in these patients.Fifty-two patients with non-specific CLBP, between 21 and 62 years of age, 50% men, were investigated. Lumbar MRI was employed to assess disc degeneration, endplate changes, Modic changes, disc displacement, facet degeneration, foraminal stenosis and central lumbar spinal stenosis. The characteristics of pain were evaluated and patients were divided into 2 subgroups: with NP (24 patients) and without NP (28 patients), based on the results of a DN4-interview. Correlations between particular MRI changes and their relations to the intensity of pain were evaluated. Logistic regression was used to disclose predictors of NP.Lumbar spine degenerative features were frequent in patients with non-specific CLBP, with L4/5 the most affected level. A significant correlation emerged between the severity of degenerative changes in particular lumbar spine structures (correlation coefficient ranging between 0.325 and 0.573), while no correlation was found between severity of degenerative changes and pain. Multivariate logistic regression revealed only 2 independent predictors of NP - female sex (odds ratio [OR] = 11.9) and a mean pain intensity of ≥4.5 in the previous 4 weeks (OR = 13.1).Degenerative changes in the lumbar spine are frequent MRI findings, but do not correlate with the intensity of pain and do not predict NP. However, female sex and pain intensity do predict NP.
- MeSH
- bederní obratle diagnostické zobrazování MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie diagnostické zobrazování MeSH
- magnetická rezonanční tomografie * MeSH
- měření bolesti MeSH
- mladý dospělý MeSH
- nemoci páteře diagnostické zobrazování MeSH
- neuralgie diagnóza MeSH
- prognóza MeSH
- průřezové studie MeSH
- sexuální faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Častou příčinou bolestí zad může být dysfunkce sakroiliakálního (SI) skloubení. Projevují se pseudoradikulární bolestí a jsou spojeny s pozitivními manévry na sakropelvická ligamenta a s provokačními testy, jako je např. Patrickův test. V terapii této bolesti používáme obstřiky SI skloubení navigované pomocí mobilního CT přístroje O-arm, kdy aplikujeme směs depotního steroidu, lokálního anestetika a rtg kontrastní látky. V našem souboru je 31 pacientů (5 mužů, 26 žen, průměrný věk 52 roků), u 58% pacientů se snížila úroveň bolesti o polovinu podle NRS (numeric rating scale) po dobu delší než 3 týdny, u 28% pacientů nastala úleva od bolestí pouze o čtvrtinu až polovinu a u 14% pacientů nebyl dosažen analgetický efekt. Tento obstřik nám slouží též jako diagnostická metoda, jestli je indikované pacientům nabídnout definitivní řešení – operační dézu SI skloubení.
Sacroiliac joint dysfunction can often be the cause of chronic low back pain. The main symptom is pseudoradicular leg pain as well as positive maneuvers of the sacropelvic ligaments and the Patrick' test. We used a mixture of depot steroid, local anesthetic and contrast medium for navigated sacroiliac joint injections using O-arm, portable CT scanner. There are 31 patients in our study group, 5 male and 26 female, average age 52 years. In 58% of cases we achieved pain relief of more than one-half on the Numeric Rating Scale for 3 weeks or more, in 28% of cases we achieved pain relief of one quarter to one half and in 14% patients showed no pain relief. We utilize these injections as a diagnostic tool for selecting patients suitable for sacroiliac arthrodesis.
- MeSH
- chronická nemoc MeSH
- diagnostické zobrazování metody MeSH
- injekce intraartikulární metody přístrojové vybavení MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování terapie MeSH
- počítačová rentgenová tomografie MeSH
- sakroiliakální kloub diagnostické zobrazování účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
Fazetové kĺby boli prvýkrát opísané ako možný zdroj bolesti chrbta v roku 1933. Bolesti chrbta sú v súčasnosti najčastejším typom bolesti u človeka. Často sú dôsledkom degeneratívnych zmien na chrbtici vrátane fazetových kĺbov a postihujú značnú časť populácie ešte v produktívnom veku. Na zvyšujúcom sa počte chronických bolestí chrbta sa podieľajú vplyvy psychologické, sociálne aj ekonomické. Intervenčná diagnostika a terapia bolesti chrbta je v porovnaní s ostatnými medicínskymi odbormi ich oveľa mladším súrodencom. Máme tak väčšie možnosti pomôcť pacientom s lumbálnym fazetovým syndrómom efektívnou kauzálnou liečbou.
Facet joints were first described as a possible origin of back pain in 1933. Back pain is now the most common type of pain in humans. They are often the result of degenerative changes in the spine, including the facet joints, affecting a significant portion of the population still of working age. For an increasing number of chronic back pain involved in the effects of psychological, social and economic. Intervention diagnosis and treatment of back pain is compared to other medical disciplines their much younger siblings. We have this greater opportunity to help patients with lumbar facet syndrome causally effective treatment.
- Klíčová slova
- radiofrekvenční perkutánní termoablační denervace, lumbální fasetový syndrom,
- MeSH
- chronická bolest chirurgie MeSH
- denervace * metody MeSH
- katetrizační ablace MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování chirurgie patofyziologie MeSH
- meziobratlový kloub * inervace MeSH
- syndrom MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- bolesti zad diagnostické zobrazování diagnóza patofyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie * diagnostické zobrazování diagnóza patofyziologie MeSH
- lumbosakrální krajina diagnostické zobrazování inervace MeSH
- nocicepce fyziologie MeSH
- pánevní bolest diagnostické zobrazování patofyziologie MeSH
- spoušťové body diagnostické zobrazování MeSH
- tělesná teplota MeSH
- termografie * metody statistika a číselné údaje MeSH
- výhřez meziobratlové ploténky diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- klinická studie MeSH
