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Фасеточный синдром: причины возникновения, клиника, диагностика и лечение
Фасеточный синдром: причины возникновения, клиника, диагностика и лечение
Исайкин А.И., Кузнецов И.В., Кавелина А.В., Иванова М.А. Фасеточный синдром: причины возникновения, клиника, диагностика и лечение. Consilium Medicum. 2016; 18 (2): 53–61. DOI: 10.26442/2075-1753_2016.2.53-61
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Аннотация
В настоящее время принята биопсихосоциальная модель боли в спине, в которой выделяют биологическую составляющую с выявлением анатомических источников боли, а также психологический и социальный компоненты, способствующие возникновению и поддержанию болей в спине. Группа пациентов с неспецифическими болями в спине неоднородна, что требует дифференцированного подхода к лечению. Наиболее частыми источниками боли в спине являются патологически измененные диски, фасеточные суставы, крестцово-подвздошное сочленение, спазмированные мышцы, однако определение основного источника боли затруднено в связи с недостаточной валидностью используемых тестов. Фасеточные (дугоотростчатые суставы) являются единственными типичными синовиальными суставами позвоночника. В развитии патологии придается значение нескольким факторам: микро- и макротравматизации, усилению нагрузки на суставы при дегенерации диска, воспалительному поражению в виде артрита, сходному с поражением других периферических синовиальных суставов. Возможные механизмы возникновения боли включают растяжение капсулы сустава, ущемление складок синовиальной оболочки (менискоидов) между суставными поверхностями, сдавление корешка остеофитами и воспаление внутри сустава с развитием вторичного мышечного спазма. Фасетогенные боли преобладают в старших возрастных группах, несколько чаще у женщин с повышенным индексом массы тела. Отсутствует корреляция между морфологическими изменениями фасеточных суставов и болями в спине. Сочетание положительных и отрицательных тестов с учетом клинических проявлений и жалоб пациента может помочь в определении основного источника боли. «Золотым стандартом» диагностики является проведение диагностической блокады с местными анестетиками, выполненное под контролем нейровизуализации с уменьшением боли не менее чем на 70–80%. Лечение фасеточного синдрома проводят согласно общим принципам лечения неспецифических болей в спине с использованием методов медикаментозной и немедикаментозной терапии. Медикаментозное лечение на ранних этапах включает в качестве препаратов выбора назначение нестероидных противовоспалительных препаратов и миорелаксантов. В нескольких исследованиях показаны эффективность и безопасность применения баклофена в терапии острых и хронических болей в пояснице. При неэффективности в течение 3 мес рекомендовано применение разных вариантов блокад фасеточных суставов и радиочастотной денервации.
Ключевые слова: неспецифическая боль в спине, фасеточный синдром, баклофен, опросник STarT Back tool, мультидисциплинарное лечение, когнитивно-поведенческая терапия, блокады при болях в спине, радиочастотная деструкция.
Key words: non-specific back pain, facet syndrome, baclofen, a questionnaire STarT Back tool, multidisciplinary treatment, cognitive-behavioral therapy, blockade for pain in the back, radio-frequency destruction.
Ключевые слова: неспецифическая боль в спине, фасеточный синдром, баклофен, опросник STarT Back tool, мультидисциплинарное лечение, когнитивно-поведенческая терапия, блокады при болях в спине, радиочастотная деструкция.
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Key words: non-specific back pain, facet syndrome, baclofen, a questionnaire STarT Back tool, multidisciplinary treatment, cognitive-behavioral therapy, blockade for pain in the back, radio-frequency destruction.
Полный текст
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2. Kosloff T, Elton D, Shulman St. Conservative Spine Care: Opportunities to Improve the Quality and Value of Care Popul Health Manag 2013; 16 (6): 390–6.
3. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
4. Podchufarova E.V., Iakhno N.N. Bol' v spine. M.: GEOTAR-Media, 2010. [in Russian]
5. Van Tulder M, Becker A, Trudy B et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): S169–S191.
6. Parfenov V.A, Gerasimova O.N. Lechenie nespetsificheskikh bolei v spine v ambulatornoi praktike. Sprav. poliklin. vracha. 2013; 1: 48–51. [in Russian]
7. Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147 (7): 478–91.
8. Koes B, Van Tulder M, Chung-Wei CL. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075–94.
9. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patient presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60 (10): 3072–80. Doi: 10.1002/art.24853.
10. Carey TS, Freburger JK, Holmes GM et al. A long way to go: Practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976) 2009; 34: 718–24.
11. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: Time to back off? J Am Board Fam Med 2009; 22: 62–8.
12. Manchikanti L, Standiford Helm, Vijay Singh et al. Algorithmic Approach for Clinical Management of Chronic Spinal Pain. Pain Physician 2009; 12: E225–E264.
13. Hancock MJ, Maher CG, Laslett M et al. Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? Eur Spine J 2011; 20 (12): 2105–10.
14. Brennan GP, Fritz JM, Hunter SJ et al. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31 (6): 623–31.
15. Amirdelfan K, McRoberts P, Deer TR. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation 2014; 17 (Suppl. 2): 11–7.
16. Deyo RA, Weinstein JN. Low Back Pain. N Engl J Med 2001; 344 (5): 363–70.
17. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med 2011; 12 (2): 224–33.
18. Laplante BL, Ketchum JM, Saullo TR, DePalma MJ. Multivariable analysis of the relationship between pain referral patterns and the source of chronic low back pain. Pain Physician 2012; 15 (2): 171–8.
19. Laslett M, McDonald B, Aprill CN et al. Clinical predictors of screening lumbar zygapophyseal joint blocks: Development of clinical prediction rules. Spine J 2006; 6: 370–9.
20. Hancock MJ, Maher CG, Latimer J et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 2007; 16 (10): 1539–50.
21. Hirsch С, Ingelmark BE, Miller M. The anatomical basis for low back pain. Acta Orthop Scand 1963; 33: 1.
22. Lewin Т, Moffets S, Vndik A. The morphology of the lumbar synovial intervertebral joints. Acta Morphologica Netherlands Scand 1962 (4): 299.
23. Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976; 115: 149.
24. Jackson RP. The facet syndrome: Myth or reality? Clin Orthop 1992; 121: 110–21.
25. Schwarzer AC, Aprill CN, Derby R et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976) 1994; 19 (10): 1132–7.
26. Yang KH, King AI. Mechanism of Facet Load Transmission as a Hypothesis for Low-Back Pain. Spine 1986; 9 (6): 557–65.
27. Varlotta GP, Lefkowitz TR, Schweitzer M et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 2011; 40 (1): 13–23.
28. Jaumard NV, Welch WC, Winkelstein А. Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions. J Biomech Eng 2011; 133 (7).
29. Lee KE, Davis MB, Mejilla RM, Winkelstein BA. In vivo cervical facet capsule distraction: mechanical implications for whiplash and neck pain. Stapp Car Crash J 2004; 48: 373–95.
30. Videman T, Battie MC, Gill K et al. Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 1995; 20 (8): 928–35.
31. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013; 9: 216–22.
32. Suri P, Dharamsi AS, Gaviola G, Isaac Z. Are facet joint bone marrow lesions and other facet joint features associated with low back pain? A pilot study. PM R 2013; 5: 194–200.
33. Goode А, Carey Т, Jordan J. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related? Curr Rheumatol Rep 2013; 15 (2): 305.
34. Kang YM, Choi WS, Pickar JG. Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues. Spine (Phila Pa 1976) 2002; 27 (3): E56–63.
35. Bykowski JL, Wong WH. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol 2012; 33 (8): 1419–26.
36. Rubinstein SM, Van Tulder M. A best-evidence review of diagnostic proceduresfor neck and low-back pain. Best Pract Res Clin Rheumatol 2008; 22: 471–82.
37. Misaggi B, Gallazzi M, Colombo M, Ferraro M. Articular facets syndrome: diagnostic grading and treatment options. Eur Spine J 2009; 18 (Suppl. 1): 49–51.
38. Morris CE. Low back pain syndromes. Integrated clinical Management. New York: Mc Graw-Hill, 2006; p. 229–33.
39. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987; 164: 227–30.
40. Weishaupt D, Zanetti M, Boos N et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215–9.
41. Maataoui A, Vogl TJ, Middendorp M et al. Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol 2014; 6 (11): 881–5.
42. Mainka T, Lemburg SP, Heyer CM et al. Association between clinical signs assessed by manual segmental examination and findings of the lumbar facet joints on magnetic resonance scans in subjects with and without current low back pain: a prospective, single-blind study. Pain 2013; 154 (9): 1886–95.
43. Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine (Phila Pa 1976) 2002; 27 (22): 2538–45.
44. Cohen SP, Huang JH, Brummett C. Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol 2013; 9 (2): 101–16.
45. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am 2007; 91 (2): 229–39.
46. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65 (4): 653–60.
47. Vining R, Potocki, Seidman A. Paige Morgenthal An evidence-based diagnostic classification system for low back pain. J Can Chiropr Assoc 2013; 57 (3): 189–204.
48. McCarberg BH, Ruoff GE, Tenzer-Iglesias P, Weil AJ. Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med 2011; 12 (Suppl. 4): S119–27.
49. Bigos SJ, Holland J, Holland C et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J 2009; 9 (2): 147–68.
50. Buchbinder R, Pransky G, Hayden J. Recent advances in the evaluation and management of nonspecific low back pain and related disorders. Best Pract Res Clin Rheumatol 2010; 24 (2): 147–53.
51. Lee J, Gupta S, Price C, Baranowski AP. Low back and radicular pain: a pathway for care developed by the British Pain Society. J Anaesth 2013; 111 (1): 112–20.
52. Roelofs PD, Deyo RA, Koes BW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 2008; 1: CD000396.
53. White AP, Arnold PM, Norvell DC et al. Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine (Phila Pa 1976) 2011; 36 (21 Suppl.): S131–43.
54. Van Tulder MW, Touray T, Furlan AD et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev 2003; 2.
55. Chou R. Pharmacological management of low back pain. Drugs 2010; 70 (4): 387–402.
56. Parfenov V. A., Batysheva T.T. Boli v spine: boleznennyi myshechnyi spazm i ego lechenie miorelaksantami. Lechashchii vrach. 2013; 4: 16–8. [in Russian]
57. Dapas F, Hartman SF, Martinez L et al. Baclofen for the treatment of acute low-back syndrome. A double-blind comparison with placebo. Spine (Phila Pa 1976) 1985; 10 (4): 345–9.
58. Koreshkina M.I. Baklosan (baklofen) v lechenii bolei v spine: rezul'taty mnogotsentrovogo issledovaniia BRAVO. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2009; 8: 68–9. [in Russian]
59. Raphael JH, Southall JL, Gnanadurai TV et al. Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain. BMC Musculoskelet Disord 2002; 3: 17.
60. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 2): S.192–300.
61. Chou R. Low back pain (chronic). BMJ Clin Evid 2010; 2010: 1116.
62. Kаssis А. Antidepressants to Treat Nonspecific Low Back Pain. Am Fam Physician 2008; 78 (1): 51–2.
63. Hill JC, Whitehurst DG, Lewis M et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378 (9802): 1560–71.
64. Kamper SJ, Apeldoorn AT, Chiarotto A et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014; 9: CD000963.
65. Van Middelkoop M, Rubinstein SM, Kuijpers T et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011; 20 (1): 19–39.
66. Staal JB, De Bie R, De Vet HC et al. Injection therapy for subacute and chronic low back pain: An updated Cochrane review. Spine (Phila Pa 1976) 2009; 34: 49–59.
67. Manchikanti L, Abdi S, Atluri S et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 2013; 16 (2 Suppl.): S49–283.
68. Chambers H. Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 2013; 11 (2): 106–20.
69. Lakemeier S, Lind M, Schultz W et al. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg 2013; 117 (1): 228–35.
70. Falco FJ, Manchikanti L, Datta S et al. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician 2012; 15 (6): E909–53.
71. Ribeiro LH, Furtado RN, Konai MS et al. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2013; 38 (23): 1995–2002.
72. Ha DH, Shim DM, Kim TK et al. Comparison of ultrasonography- and fluoroscopy-guided facet joint block in the lumbar spine. Asian Spine J 2010; 4 (1): 15–22.
73. Henschke N, Kuijpers T, Rubinstein SM et al. Injection therapy and denervation procedures for chronic low-back pain: a systematic review. Eur Spine J 2010; 19 (9): 1425–49.
74. Chou R, Hashimoto R, Friedly J et al. Pain Management Injection Therapies for Low Back Pain [Internet]. Agency for Healthcare Research and Quality (US); 2015 Mar. AHRQ Technology Assessments.
75. Clinical Management of Chronic Spinal Pain. Pain Physician 2009; 12: E225–E264.
76. Van Tulder К. Diagnosis and treatment of sciatic. BMJ 2007; 334: 1313.
2. Kosloff T, Elton D, Shulman St. Conservative Spine Care: Opportunities to Improve the Quality and Value of Care Popul Health Manag 2013; 16 (6): 390–6.
3. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
4. Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа, 2010. / Podchufarova E.V., Iakhno N.N. Bol' v spine. M.: GEOTAR-Media, 2010. [in Russian]
5. Van Tulder M, Becker A, Trudy B et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): S169–S191.
6. Парфенов В.А., Герасимова О.Н. Лечение неспецифических болей в спине в амбулаторной практике. Справ. поликлин. врача. 2013; 1: 48–51. / Parfenov V.A, Gerasimova O.N. Lechenie nespetsificheskikh bolei v spine v ambulatornoi praktike. Sprav. poliklin. vracha. 2013; 1: 48–51. [in Russian]
7. Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147 (7): 478–91.
8. Koes B, Van Tulder M, Chung-Wei CL. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075–94.
9. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patient presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60 (10): 3072–80. Doi: 10.1002/art.24853.
10. Carey TS, Freburger JK, Holmes GM et al. A long way to go: Practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976) 2009; 34: 718–24.
11. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: Time to back off? J Am Board Fam Med 2009; 22: 62–8.
12. Manchikanti L, Standiford Helm, Vijay Singh et al. Algorithmic Approach for Clinical Management of Chronic Spinal Pain. Pain Physician 2009; 12: E225–E264.
13. Hancock MJ, Maher CG, Laslett M et al. Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? Eur Spine J 2011; 20 (12): 2105–10.
14. Brennan GP, Fritz JM, Hunter SJ et al. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31 (6): 623–31.
15. Amirdelfan K, McRoberts P, Deer TR. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation 2014; 17 (Suppl. 2): 11–7.
16. Deyo RA, Weinstein JN. Low Back Pain. N Engl J Med 2001; 344 (5): 363–70.
17. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med 2011; 12 (2): 224–33.
18. Laplante BL, Ketchum JM, Saullo TR, DePalma MJ. Multivariable analysis of the relationship between pain referral patterns and the source of chronic low back pain. Pain Physician 2012; 15 (2): 171–8.
19. Laslett M, McDonald B, Aprill CN et al. Clinical predictors of screening lumbar zygapophyseal joint blocks: Development of clinical prediction rules. Spine J 2006; 6: 370–9.
20. Hancock MJ, Maher CG, Latimer J et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 2007; 16 (10): 1539–50.
21. Hirsch С, Ingelmark BE, Miller M. The anatomical basis for low back pain. Acta Orthop Scand 1963; 33: 1.
22. Lewin Т, Moffets S, Vndik A. The morphology of the lumbar synovial intervertebral joints. Acta Morphologica Netherlands Scand 1962 (4): 299.
23. Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976; 115: 149.
24. Jackson RP. The facet syndrome: Myth or reality? Clin Orthop 1992; 121: 110–21.
25. Schwarzer AC, Aprill CN, Derby R et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976) 1994; 19 (10): 1132–7.
26. Yang KH, King AI. Mechanism of Facet Load Transmission as a Hypothesis for Low-Back Pain. Spine 1986; 9 (6): 557–65.
27. Varlotta GP, Lefkowitz TR, Schweitzer M et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 2011; 40 (1): 13–23.
28. Jaumard NV, Welch WC, Winkelstein А. Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions. J Biomech Eng 2011; 133 (7).
29. Lee KE, Davis MB, Mejilla RM, Winkelstein BA. In vivo cervical facet capsule distraction: mechanical implications for whiplash and neck pain. Stapp Car Crash J 2004; 48: 373–95.
30. Videman T, Battie MC, Gill K et al. Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 1995; 20 (8): 928–35.
31. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013; 9: 216–22.
32. Suri P, Dharamsi AS, Gaviola G, Isaac Z. Are facet joint bone marrow lesions and other facet joint features associated with low back pain? A pilot study. PM R 2013; 5: 194–200.
33. Goode А, Carey Т, Jordan J. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related? Curr Rheumatol Rep 2013; 15 (2): 305.
34. Kang YM, Choi WS, Pickar JG. Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues. Spine (Phila Pa 1976) 2002; 27 (3): E56–63.
35. Bykowski JL, Wong WH. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol 2012; 33 (8): 1419–26.
36. Rubinstein SM, Van Tulder M. A best-evidence review of diagnostic proceduresfor neck and low-back pain. Best Pract Res Clin Rheumatol 2008; 22: 471–82.
37. Misaggi B, Gallazzi M, Colombo M, Ferraro M. Articular facets syndrome: diagnostic grading and treatment options. Eur Spine J 2009; 18 (Suppl. 1): 49–51.
38. Morris CE. Low back pain syndromes. Integrated clinical Management. New York: Mc Graw-Hill, 2006; p. 229–33.
39. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987; 164: 227–30.
40. Weishaupt D, Zanetti M, Boos N et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215–9.
41. Maataoui A, Vogl TJ, Middendorp M et al. Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol 2014; 6 (11): 881–5.
42. Mainka T, Lemburg SP, Heyer CM et al. Association between clinical signs assessed by manual segmental examination and findings of the lumbar facet joints on magnetic resonance scans in subjects with and without current low back pain: a prospective, single-blind study. Pain 2013; 154 (9): 1886–95.
43. Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine (Phila Pa 1976) 2002; 27 (22): 2538–45.
44. Cohen SP, Huang JH, Brummett C. Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol 2013; 9 (2): 101–16.
45. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am 2007; 91 (2): 229–39.
46. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65 (4): 653–60.
47. Vining R, Potocki, Seidman A. Paige Morgenthal An evidence-based diagnostic classification system for low back pain. J Can Chiropr Assoc 2013; 57 (3): 189–204.
48. McCarberg BH, Ruoff GE, Tenzer-Iglesias P, Weil AJ. Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med 2011; 12 (Suppl. 4): S119–27.
49. Bigos SJ, Holland J, Holland C et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J 2009; 9 (2): 147–68.
50. Buchbinder R, Pransky G, Hayden J. Recent advances in the evaluation and management of nonspecific low back pain and related disorders. Best Pract Res Clin Rheumatol 2010; 24 (2): 147–53.
51. Lee J, Gupta S, Price C, Baranowski AP. Low back and radicular pain: a pathway for care developed by the British Pain Society. J Anaesth 2013; 111 (1): 112–20.
52. Roelofs PD, Deyo RA, Koes BW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 2008; 1: CD000396.
53. White AP, Arnold PM, Norvell DC et al. Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine (Phila Pa 1976) 2011; 36 (21 Suppl.): S131–43.
54. Van Tulder MW, Touray T, Furlan AD et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev 2003; 2.
55. Chou R. Pharmacological management of low back pain. Drugs 2010; 70 (4): 387–402.
56. Парфенов В. А., Батышева Т.Т. Боли в спине: болезненный мышечный спазм и его лечение миорелаксантами. Лечащий врач. 2013; 4: 16–8. / Parfenov V. A., Batysheva T.T. Boli v spine: boleznennyi myshechnyi spazm i ego lechenie miorelaksantami. Lechashchii vrach. 2013; 4: 16–8. [in Russian]
57. Dapas F, Hartman SF, Martinez L et al. Baclofen for the treatment of acute low-back syndrome. A double-blind comparison with placebo. Spine (Phila Pa 1976) 1985; 10 (4): 345–9.
58. Корешкина М.И. Баклосан (баклофен) в лечении болей в спине: результаты многоцентрового исследования BRAVO. Журн. неврологии и психиатрии им. С.С.Корсакова. 2009; 8: 68–9. / Koreshkina M.I. Baklosan (baklofen) v lechenii bolei v spine: rezul'taty mnogotsentrovogo issledovaniia BRAVO. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2009; 8: 68–9. [in Russian]
59. Raphael JH, Southall JL, Gnanadurai TV et al. Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain. BMC Musculoskelet Disord 2002; 3: 17.
60. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 2): S.192–300.
61. Chou R. Low back pain (chronic). BMJ Clin Evid 2010; 2010: 1116.
62. Kаssis А. Antidepressants to Treat Nonspecific Low Back Pain. Am Fam Physician 2008; 78 (1): 51–2.
63. Hill JC, Whitehurst DG, Lewis M et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378 (9802): 1560–71.
64. Kamper SJ, Apeldoorn AT, Chiarotto A et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014; 9: CD000963.
65. Van Middelkoop M, Rubinstein SM, Kuijpers T et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011; 20 (1): 19–39.
66. Staal JB, De Bie R, De Vet HC et al. Injection therapy for subacute and chronic low back pain: An updated Cochrane review. Spine (Phila Pa 1976) 2009; 34: 49–59.
67. Manchikanti L, Abdi S, Atluri S et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 2013; 16 (2 Suppl.): S49–283.
68. Chambers H. Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 2013; 11 (2): 106–20.
69. Lakemeier S, Lind M, Schultz W et al. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg 2013; 117 (1): 228–35.
70. Falco FJ, Manchikanti L, Datta S et al. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician 2012; 15 (6): E909–53.
71. Ribeiro LH, Furtado RN, Konai MS et al. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2013; 38 (23): 1995–2002.
72. Ha DH, Shim DM, Kim TK et al. Comparison of ultrasonography- and fluoroscopy-guided facet joint block in the lumbar spine. Asian Spine J 2010; 4 (1): 15–22.
73. Henschke N, Kuijpers T, Rubinstein SM et al. Injection therapy and denervation procedures for chronic low-back pain: a systematic review. Eur Spine J 2010; 19 (9): 1425–49.
74. Chou R, Hashimoto R, Friedly J et al. Pain Management Injection Therapies for Low Back Pain [Internet]. Agency for Healthcare Research and Quality (US); 2015 Mar. AHRQ Technology Assessments.
75. Clinical Management of Chronic Spinal Pain. Pain Physician 2009; 12: E225–E264.
76. Van Tulder К. Diagnosis and treatment of sciatic. BMJ 2007; 334: 1313.
________________________________________________
2. Kosloff T, Elton D, Shulman St. Conservative Spine Care: Opportunities to Improve the Quality and Value of Care Popul Health Manag 2013; 16 (6): 390–6.
3. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
4. Podchufarova E.V., Iakhno N.N. Bol' v spine. M.: GEOTAR-Media, 2010. [in Russian]
5. Van Tulder M, Becker A, Trudy B et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): S169–S191.
6. Parfenov V.A, Gerasimova O.N. Lechenie nespetsificheskikh bolei v spine v ambulatornoi praktike. Sprav. poliklin. vracha. 2013; 1: 48–51. [in Russian]
7. Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147 (7): 478–91.
8. Koes B, Van Tulder M, Chung-Wei CL. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075–94.
9. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patient presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60 (10): 3072–80. Doi: 10.1002/art.24853.
10. Carey TS, Freburger JK, Holmes GM et al. A long way to go: Practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976) 2009; 34: 718–24.
11. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: Time to back off? J Am Board Fam Med 2009; 22: 62–8.
12. Manchikanti L, Standiford Helm, Vijay Singh et al. Algorithmic Approach for Clinical Management of Chronic Spinal Pain. Pain Physician 2009; 12: E225–E264.
13. Hancock MJ, Maher CG, Laslett M et al. Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? Eur Spine J 2011; 20 (12): 2105–10.
14. Brennan GP, Fritz JM, Hunter SJ et al. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31 (6): 623–31.
15. Amirdelfan K, McRoberts P, Deer TR. The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation 2014; 17 (Suppl. 2): 11–7.
16. Deyo RA, Weinstein JN. Low Back Pain. N Engl J Med 2001; 344 (5): 363–70.
17. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med 2011; 12 (2): 224–33.
18. Laplante BL, Ketchum JM, Saullo TR, DePalma MJ. Multivariable analysis of the relationship between pain referral patterns and the source of chronic low back pain. Pain Physician 2012; 15 (2): 171–8.
19. Laslett M, McDonald B, Aprill CN et al. Clinical predictors of screening lumbar zygapophyseal joint blocks: Development of clinical prediction rules. Spine J 2006; 6: 370–9.
20. Hancock MJ, Maher CG, Latimer J et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 2007; 16 (10): 1539–50.
21. Hirsch С, Ingelmark BE, Miller M. The anatomical basis for low back pain. Acta Orthop Scand 1963; 33: 1.
22. Lewin Т, Moffets S, Vndik A. The morphology of the lumbar synovial intervertebral joints. Acta Morphologica Netherlands Scand 1962 (4): 299.
23. Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976; 115: 149.
24. Jackson RP. The facet syndrome: Myth or reality? Clin Orthop 1992; 121: 110–21.
25. Schwarzer AC, Aprill CN, Derby R et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976) 1994; 19 (10): 1132–7.
26. Yang KH, King AI. Mechanism of Facet Load Transmission as a Hypothesis for Low-Back Pain. Spine 1986; 9 (6): 557–65.
27. Varlotta GP, Lefkowitz TR, Schweitzer M et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol 2011; 40 (1): 13–23.
28. Jaumard NV, Welch WC, Winkelstein А. Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions. J Biomech Eng 2011; 133 (7).
29. Lee KE, Davis MB, Mejilla RM, Winkelstein BA. In vivo cervical facet capsule distraction: mechanical implications for whiplash and neck pain. Stapp Car Crash J 2004; 48: 373–95.
30. Videman T, Battie MC, Gill K et al. Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 1995; 20 (8): 928–35.
31. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013; 9: 216–22.
32. Suri P, Dharamsi AS, Gaviola G, Isaac Z. Are facet joint bone marrow lesions and other facet joint features associated with low back pain? A pilot study. PM R 2013; 5: 194–200.
33. Goode А, Carey Т, Jordan J. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related? Curr Rheumatol Rep 2013; 15 (2): 305.
34. Kang YM, Choi WS, Pickar JG. Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues. Spine (Phila Pa 1976) 2002; 27 (3): E56–63.
35. Bykowski JL, Wong WH. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol 2012; 33 (8): 1419–26.
36. Rubinstein SM, Van Tulder M. A best-evidence review of diagnostic proceduresfor neck and low-back pain. Best Pract Res Clin Rheumatol 2008; 22: 471–82.
37. Misaggi B, Gallazzi M, Colombo M, Ferraro M. Articular facets syndrome: diagnostic grading and treatment options. Eur Spine J 2009; 18 (Suppl. 1): 49–51.
38. Morris CE. Low back pain syndromes. Integrated clinical Management. New York: Mc Graw-Hill, 2006; p. 229–33.
39. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987; 164: 227–30.
40. Weishaupt D, Zanetti M, Boos N et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215–9.
41. Maataoui A, Vogl TJ, Middendorp M et al. Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol 2014; 6 (11): 881–5.
42. Mainka T, Lemburg SP, Heyer CM et al. Association between clinical signs assessed by manual segmental examination and findings of the lumbar facet joints on magnetic resonance scans in subjects with and without current low back pain: a prospective, single-blind study. Pain 2013; 154 (9): 1886–95.
43. Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine (Phila Pa 1976) 2002; 27 (22): 2538–45.
44. Cohen SP, Huang JH, Brummett C. Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol 2013; 9 (2): 101–16.
45. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am 2007; 91 (2): 229–39.
46. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65 (4): 653–60.
47. Vining R, Potocki, Seidman A. Paige Morgenthal An evidence-based diagnostic classification system for low back pain. J Can Chiropr Assoc 2013; 57 (3): 189–204.
48. McCarberg BH, Ruoff GE, Tenzer-Iglesias P, Weil AJ. Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med 2011; 12 (Suppl. 4): S119–27.
49. Bigos SJ, Holland J, Holland C et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J 2009; 9 (2): 147–68.
50. Buchbinder R, Pransky G, Hayden J. Recent advances in the evaluation and management of nonspecific low back pain and related disorders. Best Pract Res Clin Rheumatol 2010; 24 (2): 147–53.
51. Lee J, Gupta S, Price C, Baranowski AP. Low back and radicular pain: a pathway for care developed by the British Pain Society. J Anaesth 2013; 111 (1): 112–20.
52. Roelofs PD, Deyo RA, Koes BW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 2008; 1: CD000396.
53. White AP, Arnold PM, Norvell DC et al. Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine (Phila Pa 1976) 2011; 36 (21 Suppl.): S131–43.
54. Van Tulder MW, Touray T, Furlan AD et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev 2003; 2.
55. Chou R. Pharmacological management of low back pain. Drugs 2010; 70 (4): 387–402.
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Авторы
А.И.Исайкин*1, И.В.Кузнецов2, А.В.Кавелина1, М.А.Иванова1
1 ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
2 Клиника нервных болезней им. А.Я.Кожевникова. 119021, Россия, Москва, ул. Россолимо, д. 11, стр. 1
*alexisa68@mail.ru
1 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
2 A.Ya.Kozhevnikov Clinic for Nervous Diseases. 119435, Russian Federation, Moscow, ul. Rossolimo, d. 11, str. 1
*alexisa68@mail.ru
1 ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
2 Клиника нервных болезней им. А.Я.Кожевникова. 119021, Россия, Москва, ул. Россолимо, д. 11, стр. 1
*alexisa68@mail.ru
________________________________________________
1 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
2 A.Ya.Kozhevnikov Clinic for Nervous Diseases. 119435, Russian Federation, Moscow, ul. Rossolimo, d. 11, str. 1
*alexisa68@mail.ru
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