AM: Facet Graft Quells Refractory Back Pain (CME/CE)

SAN ANTONIO — Minimally invasive facet arthrodesis significantly reduced pain and improved physical function for one year in patients with medically refractory facet arthropathy, according to data from a prospective clinical series.

Most patients discontinued narcotic pain relievers, researchers reported here, and only one of 28 patients in the series had no appreciable change in pain after the noninstrumented spinal surgery.

“The procedure does not disrupt stabilizing ligaments or muscular structures of the posterior spine, allowing unimpeded physiotherapy for low back muscular strengthening after 16 weeks,” Daniel Bennett, MD, of Integrative Treatment Centers in Denver, told attendees at the American Academy of Pain Medicine meeting.

“If fusion occurs, symptoms should not return, as with traditional treatment modalities, such as thermal radiofrequency neurolysis.”

The results have provided the foundation for a prospective, multicenter, randomized clinical trial to compare radiofrequency neurolysis and minimally invasive spine facet arthrodesis, he added.

Medical management of low back pain related to facet degeneration often provides minimal pain relief and can interfere with functioning. Direct injection of anesthesia into an affected joint also leads to negligible long-term benefits, said Bennett. Radiofrequency neurolysis provides only temporary pain relief and must be repeated because of nerve regeneration.

All the patients had a return of pain after previous radiofrequency neurolysis and were eligible for repeat neurolytic procedures. Affected areas were confirmed by anesthetic injection, followed by a provocatory examination.

The patients underwent a standardized procedure that included a small incision at the affected area, insertion of surgical pins to stabilize the joint, use of a surgical drill to achieve joint separation, and insertion of 5-mm or 7-mm Morse tapered cortical allografts.

After surgery, patients wore a rigid brace for 16 weeks, at which point they began physical therapy to strengthen back muscles.

The patients received a total of 102 grafts at 51 levels, and four dislodgements (3.9%) occurred. None of the patients had a return of pain after dislodgement.

“Among patients who retained grafts, all showed callus formation of the posterior joint and incorporation of the cortical allograft,” said Bennett.

At the 52-week follow-up, the average score on a 100-point visual analog pain scale was 23, down from an average of 79 prior to the intervention. Patients’ scores on the Oswestry Disability Index averaged 8.32, compared with 33.46 at baseline.

All but four patients discontinued narcotic medication, and the morphine dose required by those four decreased from a baseline range of 150 to 360 mg to a range of 10 to 30 mg at one year.

The study was supported by Prism Healthcare Foundation.

Bennett disclosed relationships with Alphatec Spine, miniSURG, Boston Scientific, Cephalon, Nevro, and Paylon.

source : www.medpagetoday.com

Related News:

• SGO: New Option for Recurrent Ovarian Cancer? (CME/CE)
• Pregnancy Linked to Critical H1N1 Illness (CME/CE)
• Greater Infection Risk with Staples in Hip Surgery (CME/CE)
• ACC: Radial Artery Matches Saphenous Vein for CABG (CME/CE)
• SIR: Combo of Embolization and Bevacizumab Safe (CME/CE)
• SIR: Cryotherapy Effective in Soft Tissue (CME/CE)
• SGO: HPV Vaccine Stops Recurrence After Surgery (CME/CE)
• SGO: No Lung CA Risk Seen with Estrogen (CME/CE)
• SSRI, Naltrexone, Talk Therapy Keep Depressed Alcoholics Dry (CME/CE)
• Gaps Remain in Cancer Palliative Care (CME/CE)