Neurosurg Focus
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Review
Guidelines for the use of discography for the diagnosis of painful degenerative lumbar disc disease.
Discography has been used as a diagnostic test in the evaluation of patients with recalcitrant low-back pain. Recently, its usefulness has been questioned because of the occurrence of false-positive results as well as the influence of psychological factors on test results. The purpose of this review is to establish the literature support for and against the use of discography. A search of the English-language literature published between 1966 and 2001 was performed. Papers were selected based on inclusion criteria described in the text, and the quality of information was graded using previously described methods. ⋯ The authors propose a set of practice parameters based on the literature. Although the data were not judged adequate for the determination of a treatment standard, parameters for the use of discography are provided at a guideline and option level.
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In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. ⋯ The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.
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Comparative Study
Indications for and benefits of lumbar facet joint block: analysis of 230 consecutive patients.
The authors evaluated the effectiveness of using a facet joint block with local anesthetic agents and or steroid medication for the treatment of low-back pain in a medium-sized series of patients. ⋯ Lumbar facet joint block is a minimally invasive procedure to differentiate between facet joint pain and other causes of lower-back pain. The procedure seems to be useful for distinguishing between facet joint pain from postoperative pain due to inappropriate neural decompression after lumbar surgery. It can be also recommended as a possible midterm intervention for chronic low-back pain.