Paravertebral spinal injection for the treatment of patients with degenerative facet osteoarthropathy: Evidence of motor performance improvements based on objective assessments

Abstract

Background: This study examined short- and long-term improvements in motor performance, quantified using wearable sensors, in response to facet spine injection in degenerative facet osteoarthropathy patients.

Methods: Adults with confirmed degenerative facet osteoarthropathy were recruited and were treated with medial or intermediate branch block injection. Self-report pain, health condition, and disability (Oswestry), as well as objective motor performance measures (gait, balance, and timed-up-and-go) were obtained in five sessions: pre-surgery (baseline), immediately after the injection, one-month, three-month, and 12-month follow-ups. Baseline motor performance parameters were compared with 10 healthy controls.

Findings: Thirty patients (age=50 (14) years) and 10 controls (age=46 (15) years) were recruited. All motor performance parameters were significantly different between groups. Results showed that average pain and Oswestry scores improved by 51% and 24%, respectively among patients, only one month after injection. Similarly, improvement in motor performance was most noticeable in one-month post-injection measurements; most improvements were observed in gait speed (14% normal walking, P<0.02), hip sway within balance tests (63% eyes-open P<0.01), and turning velocity within the timed-up-and-go test (28%, P<0.02). Better baseline motor performance led to better outcomes in terms of pain relief; baseline turning velocity was 18% faster among the responsive compared to the non-responsive patients.

Interpretations: Spinal injection can temporarily (one to three months) improve motor performance in degenerative facet osteoarthropathy patients. Successful pain relief in response to treatment is independent of demographic characteristics and initial pain but dependent on baseline motor performance. Immediate self-reported pain relief is unrelated to magnitude of gradual improvement in motor performance.

Keywords: Balance; Low back pain; Motor performance; Osteoarthropathy; Spine injection; Wearable technology.

Figure 1

Changes in pain (average pain in two weeks) and Oswestry scores by time. Mean values and standard errors are presented. Post-hoc results are illustrated using alphabetic grouping.

Figure 2

Changes in motor performance with time. Mean values and standard errors are presented for the most sensitive parameters within gait, balance, and TUG. Post-hoc results are illustrated using alphabetic grouping. (FU: follow-up)

Figure 3

Differences in baseline TUG parameters among DFO participants with and without pain relief following spinal injection. The asterisk symbol represents a significant difference.