Lumbago: An overview of minimally invasive pain therapies
Chronic back pain can also be attributed to degenerative changes, injuries and inflammation. Doctors are increasingly turning to minimally invasive therapies.
Periradicular therapy (PRT)
Periradicular therapy is a minimally invasive method in which anti-inflammatory and pain-relieving medication is injected directly into the area around the affected nerve roots. This technique is often used for pain caused by nerve root irritation, such as that caused by herniated discs or spinal stenosis. As a rule, a local anaesthetic is injected together with a contrast agent and a steroid.
In their prospective study, Reuschel et al. examined 161 patients with radicular pain syndromes who had undergone PRT. Overall, 37.9% of patients experienced significant but not long-lasting (average of four weeks) complete pain relief. Overall, 44.1% of patients experienced prolonged, subjectively satisfactory pain relief of more than four weeks and up to three months. Overall, 18% of patients had complete and sustained relief for more than six months1.
Facet joint injection
The facet joints connect the vertebrae to each other and allow the spine to move. However, in the case of degenerative diseases or injuries, these joints can cause pain. During facet joint infiltration, painkillers and anti-inflammatory drugs are injected directly into the facet joints to relieve pain and reduce inflammation.
The success rates of facet joint injections vary. Studies show that up to 92% of patients can experience pain relief for a short duration, typically 1 to 4 weeks after the injection2. Over time, symptoms may or may not return. Some patients may require repeated injections to maintain pain relief, while other patients may experience complete improvement or long-lasting pain relief.
Medial Branch Blocks (MBB)
The medial branch is a fine nerve branch that transmits pain signals from the facet joints to the central nervous system. A medial branch block is a diagnostic procedure in which an anaesthetic is injected near these nerves. If the patient experiences significant pain relief, this may indicate that the facet joints are the source of the pain. If a diagnosis is made, treatment consists of denervation of the small nerve branches using special probes (radiofrequency therapy) under X-ray control.
The study by Baroncini et al. showed that facet joint injections and medial branch blocks are effective treatments for chronic back pain, especially in facet joint arthritis. This systematic review analyses the success of various medications, including corticosteroids, hyaluronic acid, sarapin and local anaesthetics. Data from 587 patients were analysed, with steroids and sarapin being particularly effective. The results are encouraging, especially for medial branch blocks3.
Implications for medical practice
Minimally invasive pain therapies offer an effective option for the treatment of chronic back pain. However, it is important to make an accurate diagnosis using precise clinical examination and imaging. While PRT is used for radicular pain due to spinal canal stenosis and neuroforaminal stenosis, facet joint infiltration and MBB are used specifically for facet joint arthritis. The current study situation does not provide definitive results as to which agents (steroids, anaesthetics, sarapin, hyaluronic acid, etc.) are best. However, it is important that these procedures are performed by experienced physicians under sterile conditions and are part of a comprehensive treatment plan.
- Reuschel V, Scherlach C, Pfeifle C, Krause M, Struck MF, Hoffmann KT, Schob S. Treatment Effect of CT-Guided Periradicular Injections in Context of Different Contrast Agent Distribution Patterns. Diagnostics (Basel). 2022 Mar 23;12(4):787.
- Peh W. Image-guided facet joint injection. Biomed Imaging Interv J. 2011 Jan-Mar;7(1):e4.
- Baroncini A, Maffulli N, Eschweiler J, Knobe M, Tingart M, Migliorini F. Management of facet joints osteoarthritis associated with chronic low back pain: A systematic review. Surgeon. 2021 Dec;19(6):e512-e518.