Articles: low-back-pain.
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Tech Vasc Interv Radiol · Mar 2009
ReviewTreatment of facet and sacroiliac joint arthropathy: steroid injections and radiofrequency ablation.
Facet and sacroiliac joint arthropathy are common, specific causes of low back pain. With a combination of a focused physical examination and image guidance, pain originating from these joints can be accurately targeted and these joints respond well to the direct application of long-acting deposition preparation steroids. ⋯ Image guidance is a critical tool in targeting facet joint innervation, performing a central role in the techniques used in both preprocedure testing and the RFA treatment. This article reviews the basic image-guided fluoroscopic and computed tomographic-guided approaches to steroid treatment of the facet and sacroiliac joints and further discusses of the painful facet through RFA.
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Post lumbar surgery syndrome with persistent chronic low back and lower extremity pain is common in the United States. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome (FBSS). Percutaneous adhesiolysis with a catheter or direct visualization of the spinal canal and the contents with an endoscope are techniques employed in resistant cases when patients fail to respond to conservative modalities of treatment, including fluoroscopically directed epidural injections. Some patients failing to respond to percutaneous adhesiolysis are candidates for spinal endoscopic adhesiolysis. However, literature evaluating the effectiveness of spinal endoscopic adhesiolysis is sparse and discussions continue about its effectiveness, utility, and complications. ⋯ Spinal endoscopic adhesiolysis may be used as an effective treatment modality for chronic refractory low back pain and radiculopathy that is related to epidural adhesions.
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Lumbar discectomy is the most common type of back surgery performed in the United States. Outcomes after this procedure can be variable and it appears that Workers' Compensation patients might be at increased risk for poor outcomes. ⋯ Results of this study suggest that compensated back surgery patients are at greater risk for poor lumbar discectomy outcomes than noncompensation patients. Presurgery correlates of poor outcomes may be useful in identifying high-risk compensation patients.
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The aim of the current review was to determine the predictive strength of low recovery expectations for activity limitation outcomes in people with non-chronic NSLBP. ⋯ Recovery expectations when measured using a specific, time-based measure within the first 3 weeks of NSLBP can identify people at risk of poor outcome.