Author(s): Manchikanti L, Singh V, Giordano J, Manchikanti KN, Cash KA
BACKGROUND: Spinal pain is common in all age groups. While the research has focused primarily on incidence and prevalence in younger working adults, there is evidence that spinal pain is one of the most frequent complaints in older persons and is responsible for functional limitations. While facet arthrosis is a common radiographic finding, which has been suggested to be a potential cause of spinal pain, nearly 10% of all adults show signs of degeneration by the time they reach age 30. Radiographic changes of osteoarthritis have been shown to be equally common in patients with and without low back or neck pain. The studies of low back pain have shown the prevalence of facet joint involvement to be approximately 15% to 45%. However, age related prevalence of facet joint neck pain has not been studied. OBJECTIVE: To assess age-related prevalence and false-positive rates of facet-joint involvement in chronic spinal pain using controlled comparative local anesthetic blocks. DESIGN: Retrospective analysis of 424 patients, divided into 6 groups based upon age (Group I: aged 18 - 30 years, Group II: aged 31 - 40 years, Group III: aged 41 - 50 years, Group IV: aged 51 - 60, Group V: 61 - 70 years, and Group VI: greater than 70 years of age). RESULTS: The prevalence of cervical facet joint-related pain was the lowest (33%) in Group VI and highest (42%) in Group I. False-positive rates for cervical facet joint blocks ranged from 39% (Group III) to 58% (Group V) with an overall false-positive rate of 45%. The prevalence of facet joint involvement in lumbar spinal pain ranged from 18% (in Group II) to 44% (in Group IV), with significant differences noted when Group II and Group III were compared to other groups and with higher rates in Group V. CONCLUSION: This study demonstrated a variable age-related prevalence of facet joint pain in chronic low back pain, whereas in the cervical spine it was similar among all the age groups.