Lumbar facet scoring system

[ghost dog]

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Hey folks,

I recently came across this scoring system, and wondered what people think of it:

The scoring system has a total of 100 points, allocated as follows:

1. Back pain associated with groin or thigh pain: 30 points.

2. Well-localized lumbar paraspinal tenderness: 20 points

3. Reproduction of pain with extension-rotation: 30 points

4. Corresponding radiographic changes: 20 points

5. Pain below the knee: -10 points.

A score of 60 points or more indicates a very high probability of satisfactory response to facet joint injection ( 100% prolonged response in this study ).


Scoring system taken from the study:

The Lumbar Facet Syndrome

HELBIG, THOMAS MD; LEE, CASEY K. MD
1988 Jan;13(1):61-4.Abstract

A clinical study was undertaken to formulate better criteria for accurate diagnosis of the lumbar facet syndrome and for predicting treatment response to facet joint injection. Twenty-two consecutive patients with a clinical diagnosis of lumbar facet syndrome, made by conventional diagnostic criteria, who were then treated with facet joint injection, were reviewed for their treatment responses. New diagnostic criteria were formulated based on a scoring system derived from the values observed in this review study.

When only the conventional criteria were used, the overall results of prolonged relief of pain after facet joint injection was 50% . A "scorecard" system is proposed that may give a higher degree of diagnostic accuracy and predictability of successful response to facet joint injection.

 

[PMR 4 MSK]

That pretty much correlates with how I do it in my mind, sans the points.

 

[101N]

You need to change the order of the list to include increasing patient age as #1

1. Discs degenerate before facets. Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS. Spine (Phila Pa 1976). 1990 Feb;15(2):111-3.

2. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A. Eur Spine J. 1999;8(5):396-401.

3. acet joint osteoarthritis and low back pain in the community-based population. Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O'Donnell CJ, Hoffmann U, Cole R, Hunter DJ. Spine (Phila Pa 1976). 2008 Nov 1;33(23):2560-5.

 

[bedrock]

You need to change the order of the list to include increasing patient age as #1

1. Discs degenerate before facets. Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS. Spine (Phila Pa 1976). 1990 Feb;15(2):111-3.

2. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A. Eur Spine J. 1999;8(5):396-401.

3. acet joint osteoarthritis and low back pain in the community-based population. Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O'Donnell CJ, Hoffmann U, Cole R, Hunter DJ. Spine (Phila Pa 1976). 2008 Nov 1;33(23):2560-5.

1. Back pain associated with groin or thigh pain: 30 points.

I'm not sure how much groin pain increases my suspicion of lumbar facet arthropathy

 

[PMR 4 MSK]

I'm not sure how much groin pain increases my suspicion of lumbar facet arthropathy

In my mind, if they indicate groin pain going diagnonally across the joint - superolaterally to inferomedially, it is almost always hip joint.

If they just indicate vague pain at the groin, not diagnonally, I think facet or SI joint.

 

[mille125]

In my mind, if they indicate groin pain going diagnonally across the joint - superolaterally to inferomedially, it is almost always hip joint.

If they just indicate vague pain at the groin, not diagnonally, I think facet or SI joint.

I agree....Pain with abduction/adduction of the hip would also suggest hip pathology

 

[bedrock]

I agree with comments on hip, and I've seen SIJ patients presenting with groin pain, but do you guys see lumbar facet arthropathy referring to the groin as a primary feature?

 

[mid|ine]

5. Pain below the knee: -10 points.

I don't think this decreases the probability they have facet mediated pain, just that pain below the knees won't get better with treatment of the facets.

 

[mille125]

I agree with comments on hip, and I've seen SIJ patients presenting with groin pain, but do you guys see lumbar facet arthropathy referring to the groin as a primary feature?

i do

 

[mille125]

I don't think this decreases the probability they have facet mediated pain, just that pain below the knees won't get better with treatment of the facets.

it does sometimes improve but it is not common...if you look at some of the very early work that was done on facet mapping (they basically injected facets on normal patient to see what the pain pattern was) a small minority, i think it was 2 or 3 percent of patients, seemed to have facet mediated pain that referred below the knee....i have seen some patient who have relief of pain below the knee after RFA.... again it is not common but it is not zero..

 

[mid|ine]

Sure, but if it improves its a bonus. I always tell patients I don't expect any pain to improve below the knees. If you tell them 2-3% will improve, they will believe they will be in the 2-3% group.

 

[geauxg8rs]

pain below the knees sounds pretty close to radicular pain. Radicular pain mentioned anywhere in a note ever on a patient having an RFA is set up for a chip shot claims denial.
Apparently it is impossible to have more than one diagnosis on a patient.

 

[mid|ine]

pain below the knees sounds pretty close to radicular pain. Radicular pain mentioned anywhere in a note ever on a patient having an RFA is set up for a chip shot claims denial.
Apparently it is impossible to have more than one diagnosis on a patient.

I have never had a problem getting claims paid for patients with both radicular and facet mediated pain. My notes are clear and differentiate the pain generators as well as what I am treating.