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

Stojanovic, Milan P. MD*; Sethee, Jai MD*; Mohiuddin, Meraj MD*; Cheng, Jianguo MD, PhD; Barker, Amanda MD; Wang, Jing MD, PhD§; Palmer, William MD; Huang, Ambrose MD; Cohen, Steven P. MD§

doi: 10.1097/AJP.0b013e3181b8cd4d
Original Articles

Objectives: To determine the correlation between magnetic resonance imaging (MRI) pathology and the response to diagnostic facet medial branch block (MBB) and L5 dorsal ramus medial branch block and radiofrequency (RF) denervation of lumbar facet joints.

Methods: The medical records of 127 consecutive patients who underwent MBB for suspected zygapophysial joint pain were reviewed. The lumbar spine MRI of these patients was systematically graded by 2 musculoskeletal radiologists for loss of disc height, spinal stenosis, facet joint degeneration, and other forms of spinal pathology.

Results: Patients with central or foraminal spinal stenosis had statistically significant correlation with positive outcome of RF (P=0.02), but not with MBB (P=0.08). The presence of facet joint degeneration or hypertrophy was positively correlated with response to MBB (71% vs. 51%; P=0.04), but not RF. Loss of disc height did not correlate with outcome of MBB (P=0.08) and RF (P=0.29). For other spinal pathology, no significant differences were noted for either the response to diagnostic blocks or the RF denervation. Younger patients were more likely to fail MBB (P<0.01) but not RF denervation (P=0.38).

Discussion: Whereas some relationships were noted between MRI findings and the response to lumbar facet joint interventions, many of these correlations tended to be weak. However, this study does suggest the possibility that patients with spinal stenosis, often considered an exclusion criterion for facet interventions, may respond to RF denervation of facet joints. Prospective studies are needed to confirm these observations.

*Department of Anesthesia and Critical Care, MGH Center for Pain Medicine

Department of Radiology, Musculoskeletal Imaging

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH

§Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine, Baltimore, MD

No funding used for this manuscript.

Reprints: Milan P. Stojanovic, MD, Department of Anesthesia and Critical Care, MGH Center for Pain Medicine 15 Parkman Street Boston, MA 02114 (e-mail: mpstojanovic@gmail.com).

Received for publication April 3, 2009

revised July 13, 2009

accepted July 20, 2009

© 2010 Lippincott Williams & Wilkins, Inc.