Lomber dejeneratif patolojilere bağlı bel ağrısında faset eklem enjeksiyonunun etkinliğinin değerlendirilmesi

Öz

ÖZET Amaç: Bel ağrısı, yetişkinlerde en çok rastlanan kas-iskelet sistemi rahatsızlıklarındandır. Faset eklem ile ilişkili ağrıların kronik bel ağrısının %15-40’ından sorumlu olduğu düşünülmektedir. Çalışmamızda dejeneratif patolojilere bağlı bel ağrısında faset eklem enjeksiyonunun etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamızda 2022-2023 yılları arasında Yozgat Şehir Hastanesi nöroşirurji polikliniğine başvuran lomber dejeneratif patolojilere bağlı bel ağrısı tanısı konulmuş 140 hastaya ameliyathane şartlarında floroskopi eşliğinde lokal anestezi altında faset eklem enjeksiyonu uygulanmış olup işlem öncesi ve işlem sonrasında Visual Analog Scale (VAS) kullanılarak ağrı düzeyleri değerlendirilmiştir. Bulgular: Çalışmamızda kadın hastaların oranının %30,7 ve erkek hastaların oranının %69,3 olduğu görülmüştür. Ek hastalığı olan hastaların oranı %53,6 iken, ek hastalığı olmayanların oranı %46,4 olarak saptanmıştır. Lomber operasyon geçiren hastaların oranı %14,3, travma geçiren hastaların oranı ise %8,6 olarak belirlenmiştir. Enjeksiyon yapılan hastalarda preoperatif dönemde yüksek VAS değerleri saptanmış ve postoperatif dönemde bu değerlerin anlamlı derecede düştüğü gözlemlenmiştir (p < 0,001). Sonuç: Bel ağrısında kontrendikasyonlar dışındaki durumlarda lomber faset eklem enjeksiyonu ile ağrı blokajı yöntemi; uygulanma kolaylığı, hızlı sonuç alınması ve cerrahi girişimlere göre daha az riske sahip olması yönüyle öncelikle tercih edilmesi gereken yöntemlerdir. Ek hastalık varlığı, ileri yaş, cerrahi istemeyen ya da cerrahi için uygun olmayan hastalarda ağrı yönetiminde akla mutlaka gelmelidir. Gelecekte yapılacak çalışmalar, daha geniş hasta grupları üzerinde yürütülerek tedavi yöntemlerinin uzun vadeli etkilerini değerlendirmelidir. Ayrıca, travma öyküsü ve ek hastalık gibi faktörlerin tedavi sonuçları üzerindeki etkileri daha ayrıntılı olarak incelenmelidir. Anahtar Kelimeler: Lomber dejeneratif patolojiler, faset eklem enjeksiyonu, bel ağrısı, ağrı yönetimi, minimal invaziv tedavi. ABSTRACT Aim: Low back pain is one of the most common musculoskeletal disorders in adults. It is thought that facet joint-related pain is responsible for 15-40% of chronic low back pain. Our study aimed to evaluate the effectiveness of facet joint injection in low back pain due to degenerative pathologies. Material and Methods: In our study, facet joint injection was applied to 140 patients diagnosed with low back pain due to lumbar degenerative pathologies who applied to Yozgat City Hospital neurosurgery clinic between 2022 and 2023, under local anesthesia with fluoroscopy under operating room conditions, and pain levels were evaluated using the Visual Analog Scale (VAS) before and after the procedure. Results: In our study, the rate of female patients was 30.7% and the rate of male patients was 69.3%. While the rate of patients with comorbidities was 53.6%, the rate of patients without comorbidities was 46.4%. The rate of patients who had lumbar surgery was determined as 14.3%, and the rate of patients who had trauma was 8.6%. High VAS values were detected in the preoperative period in patients who received injections, and it was observed that these values decreased significantly in the postoperative period (p < 0.001). Conclusion: Lumbar facet joint injection and pain blockade method in low back pain are the methods that should be preferred primarily due to their ease of application, rapid results and less risk than surgical interventions. The presence of comorbidities, advanced age, and patients who do not want surgery or are not suitable for surgery should definitely be considered in pain management. Future studies should be conducted on larger patient groups and evaluate the long-term effects of treatment methods. Additionally, the effects of factors such as trauma history and comorbidities on treatment outcomes should be examined in more detail. Keywords: Lumbar degenerative pathologies, facet joint injection, low back pain, pain management, minimally invasive treatment.

Anahtar Kelimeler

• Lomber dejeneratif patolojiler
• faset eklem enjeksiyonu
• bel ağrısı
• ağrı yönetimi
• minimal invaziv tedavi

Lomber dejeneratif patolojilere bağlı bel ağrısında faset eklem enjeksiyonunun etkinliğinin değerlendirilmesi

Öz

ABSTRACT Aim: Low back pain is one of the most common musculoskeletal disorders in adults. It is thought that facet joint-related pain is responsible for 15-40% of chronic low back pain. Our study aimed to evaluate the effectiveness of facet joint injection in low back pain due to degenerative pathologies. Material and Methods: In our study, facet joint injection was applied to 140 patients diagnosed with low back pain due to lumbar degenerative pathologies who applied to Yozgat City Hospital neurosurgery clinic between 2022 and 2023, under local anesthesia with fluoroscopy under operating room conditions, and pain levels were evaluated using the Visual Analog Scale (VAS) before and after the procedure. Results: In our study, the rate of female patients was 30.7% and the rate of male patients was 69.3%. While the rate of patients with comorbidities was 53.6%, the rate of patients without comorbidities was 46.4%. The rate of patients who had lumbar surgery was determined as 14.3%, and the rate of patients who had trauma was 8.6%. High VAS values were detected in the preoperative period in patients who received injections, and it was observed that these values decreased significantly in the postoperative period (p < 0.001). Conclusion: Lumbar facet joint injection and pain blockade method in low back pain are the methods that should be preferred primarily due to their ease of application, rapid results and less risk than surgical interventions. The presence of comorbidities, advanced age, and patients who do not want surgery or are not suitable for surgery should definitely be considered in pain management. Future studies should be conducted on larger patient groups and evaluate the long-term effects of treatment methods. Additionally, the effects of factors such as trauma history and comorbidities on treatment outcomes should be examined in more detail. Keywords: Lumbar degenerative pathologies, facet joint injection, low back pain, pain management, minimally invasive treatment.

Anahtar Kelimeler

• Lomber dejeneratif patolojiler
• faset eklem enjeksiyonu
• bel ağrısı
• ağrı yönetimi
• minimal invaziv tedavi

Kaynakça

1. Referans 1. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine 1994;19: 801-6.
2. Referans 2. Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N. The value of the provocation response in lumbar zygapophyseal joint injections. Clin J Pain 1994; 10: 309-13.
3. Referans 3. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine 2008; 33: 1766-74.
4. Referans 4. Van Tulder Mw, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine 2003; 28: 1978-92.
5. Referans 5. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2005; 30: 2153-63.
6. Referans6. O’Neill C, Owens DK. Lumbar facet joint pain: time to hit the reset button. Spine 2009; 9: 619-22.
7. Referans7. Jackson RP, Jacobs RR, Montesano PX. Facet joint injection in low- back pain: A prospective statistical study. Spine 1988; 13: 966-71.
8. Referans8. Marshall WJS And Scharstein J: Factors Affecting The Results Of Surgery relapsed Lumbar intervertebral Disc. Scot Med J 1968; 13: 38-42.

9. Referans 9. Le Doux MS, Langford KH, Spinal Cord Stimulation For The Failed Back syndrome. Spine 1993; 2:191-194.
10. Referans 10. Kaplan M, Dreyfuss P, Halbrook B, Bogduk N. The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint. Spine 1998; 23: 1847-52.
11. Referans 11. International Spine Intervention Society. Practice Guidelines for Spinal Diagnostic&Treatment Procedures. San Francisco, 2004.
12. Referans 12. Sluijter ME. Radiofrequency, Part 1: The lumbosacral region. Switzerland, FlivoPress, 2001.
13. Referans 13. Mullan S, Hekmatpanah J, Dobbin G. Percutaneus intramedullary cordotomi utilizing the unipolar anodal electrolytic lesion. J Neurosurgery 1965; 22: 548-53.
14. Referans 14. Shih C, Lin GY, Yueh KC, Lin JJ. Lumbar Zygapophyseal Joint Injections in Patients with Chronic Lower Back Pain. J Chinese Med Association 2005; 68: 59-64.
15. Referans 15. Pozzobon D, Ferreira PH, Dario AB, Almeida L, Vesentini G, Harmer AR, et al. Is there an association between diabetes and neck and back pain? A systematic review with meta-analyses. PLoS ONE 2019; 14(2): 0212030.
16. Referans 16. Amirdelfan K, McRoberts P, Deer TR. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation 2014;17: 11–7.
17. Referans 17. Becker JA, Stumbo JR. Back pain in adults. Prim Care 2013; 40: 271–88.