J Korean Med Sci.  2007 Dec;22(6):1048-1054. 10.3346/jkms.2007.22.6.1048.

Usefulness of Pain Distribution Pattern Assessment in Decision-Making for the Patients with Lumbar Zygapophyseal and Sacroiliac Joint Arthropathy

• Jung JH
• Kim HI
• Shin DA
• Shin DG
• Lee JO
• Kim HJ
• Chung JH

• KMID: 1785768
• DOI: http://doi.org/10.3346/jkms.2007.22.6.1048

Abstract

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision- making as well as in predicting the treatment outcome.

Keyword

Low Back Pain; Zygapophyseal Joint; Sacroiliac Joint; Diagnosis; Radiofrequency Neurotomy

MeSH Terms

Adult
Aged
Decision Making
Female
Humans
Joint Diseases/*diagnosis/therapy
Low Back Pain/*diagnosis/therapy
Magnetic Resonance Imaging
Male
Middle Aged
*Pain Measurement
*Sacroiliac Joint
Treatment Outcome
*Zygapophyseal Joint

Figure

• 

  Fig. 1 Types of pain distribution patterns in lumbar zygapophyseal joint arthropathy. Type A shows the pain distribution in the paravertebral area localized or band-like extension; type B combines type A and leg pain in the posterior thigh and calf; type C combines type A and leg pain in the posterior thigh only; type D demonstrates the combination of type A and leg pain confined to calf; type E, not depicted here, is the undetermined type, which does not belong to the above types.

• 

  Fig. 2 Types of pain distribution patterns in sacroiliac joint arthropathy. Type A has pain distribution in the lower back, gluteal region, and lateral aspect of the thigh; Type B is similar to type A but with the addition of groin pain; Type C has pain in the lower back and posterior aspects of the gluteal region; Type D combines type C and groin pain; Type E, not depicted here, indicates the undetermined pattern.

• 

  Fig. 3 Treatment effect depending upon the pain distribution patterns in lumbar zygapophyseal joint (A) and sacroiliac joint arthropathy (B). Favorable outcomes in nerve blocks were correlated with that of RF procedures. However, patients in type E of lumbar zygapophyseal and sacroiliac joint arthropathies showed better results from the RF procedure, despite lower rates of favorable outcomes in nerve block.

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