Pain
Michael Morgan, MD
Resident Physician
University of Miami
Pembroke Pines, Florida, United States
Eduard Tiozzo, PhD, MSCTI
Research Assistant Professor
University of Miami Miller School of Medicine
Miami, Florida, United States
Chane Price, MD
Clinical Physician
Holy Cross Medical Group
Miami, Florida, United States
Tricia Prince, DO
Assistant Professor
University of Miami Miller School of Medicine
Miami, Florida, United States
Andrew Sherman, MD, MS
Professor and Vice Chair of Education
University of Miami Miller School of Medicine
Miami, Florida, United States
Alberto Cruz, MPH
BIostatistician
University of Miami Miller School of Medicine
Miami, Florida, United States
Michael Morgan, MD
University of Miami
Miami, Florida, United States
This study aimed to evaluate the diagnostic accuracy of physical exam (PE) maneuvers—facet loading (pain on lumbar extension with lateral rotation), paraspinal tenderness, and spinous process tenderness—in identifying lumbar facet arthropathy (LFA) prior to medial branch block (MBB). The secondary objective was to assess differences in positive PE findings before the first MBB versus the second MBB and/or radiofrequency ablation (RFA) in patients with suspected LFA.
Design:
A single-center, retrospective review was conducted at the University of Miami Hospitals and Clinics, analyzing data from 06/01/2018 to 05/30/2022. The study included 89 adults with positive PE findings who received at least one MBB, excluding those with prior spine surgery, radicular pain, or incomplete records. Outcomes were ≥80% pain relief post-MBB (primary) and PE differences across interventions (secondary). Statistical analyses included chi-square tests, correlation coefficients, and multivariable logistic regressions, using R software (version 4.4.2).
Results:
Of 89 patients, 72.4% achieved ≥80% pain relief after MBB #1 (n=88), 85.2% after MBB #2 (n=61), and 91.4% after RFA (n=58). Facet loading and paraspinal tenderness were prevalent (83–88.5%), while spinous tenderness was less common (10.3–13.6%). Odds ratios for PE predicting pain relief were non-significant (p=0.365–0.974). Secondary aim results showed slight increases in facet loading (83% to 86.9–87.9%) and paraspinal tenderness (83% to 84.5–88.5%), with a decrease in spinous tenderness (13.6% to 10.3–11.5%) across interventions, though differences were not statistically tested.
Conclusions:
Facet loading and paraspinal tenderness are common in suspected LFA but lack specificity for predicting MBB/RFA success, highlighting the need for more reliable diagnostic tools. Future studies should incorporate imaging and statistical testing of PE differences to enhance LFA diagnosis.
