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Image-guided lumbar facet joint infiltration in nonradicular low back pain.

Chaturvedi A, Chaturvedi S, Sivasankar R - Indian J Radiol Imaging (2009)

Bottom Line: Facet nerve block was found to be a simple, minimally invasive, and safe procedure.With meticulous patient selection, we achieved long-term success rates of over 60%.We conclude that this method represents an important alternative treatment for nonradicular back pain.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP).

Materials and methods: Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post-lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks.

Results: A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered.

Conclusions: Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopy-guided lumbar facet joint injection showing intra-articular position of the needle tip and contrast filling the inferior recess (arrow). There is spread of contrast in the perifacetal region (arrowheads) due to rupture of the capsule.
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Figure 0006: Fluoroscopy-guided lumbar facet joint injection showing intra-articular position of the needle tip and contrast filling the inferior recess (arrow). There is spread of contrast in the perifacetal region (arrowheads) due to rupture of the capsule.

Mentions: Facet joint injection with local anesthetic and steroid is the simplest and most common procedure for facet joint–mediated pain. These infiltrations are diagnostic as well as therapeutic and the choice of guidance—whether CT or fluoroscopic—is largely a matter of personal preference and experience, as both are equally effective.[4910] The immediate pain relief after the injection is attributed to the effect of the long-acting local anesthetic which interrupts the pain–spasm cycle. The corticosteroid begins to act by 1 week and by about 3 weeks the peak effect sets in. There may be a nonspecific synovitis present in many of these joints that is relieved by the anti-inflammatory action of corticosteroids. In many cases, rupture of the articular capsule during injection results in the drugs diffusing into the neural foramina too, thus, acting on the adjacent nerves as well [Figure 6]. A simple physical effect, whereby inflammatory exudates or adhesions are cleared from the joint and the nerve root sleeve, may also play a role.[11–13]


Image-guided lumbar facet joint infiltration in nonradicular low back pain.

Chaturvedi A, Chaturvedi S, Sivasankar R - Indian J Radiol Imaging (2009)

Fluoroscopy-guided lumbar facet joint injection showing intra-articular position of the needle tip and contrast filling the inferior recess (arrow). There is spread of contrast in the perifacetal region (arrowheads) due to rupture of the capsule.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747413&req=5

Figure 0006: Fluoroscopy-guided lumbar facet joint injection showing intra-articular position of the needle tip and contrast filling the inferior recess (arrow). There is spread of contrast in the perifacetal region (arrowheads) due to rupture of the capsule.
Mentions: Facet joint injection with local anesthetic and steroid is the simplest and most common procedure for facet joint–mediated pain. These infiltrations are diagnostic as well as therapeutic and the choice of guidance—whether CT or fluoroscopic—is largely a matter of personal preference and experience, as both are equally effective.[4910] The immediate pain relief after the injection is attributed to the effect of the long-acting local anesthetic which interrupts the pain–spasm cycle. The corticosteroid begins to act by 1 week and by about 3 weeks the peak effect sets in. There may be a nonspecific synovitis present in many of these joints that is relieved by the anti-inflammatory action of corticosteroids. In many cases, rupture of the articular capsule during injection results in the drugs diffusing into the neural foramina too, thus, acting on the adjacent nerves as well [Figure 6]. A simple physical effect, whereby inflammatory exudates or adhesions are cleared from the joint and the nerve root sleeve, may also play a role.[11–13]

Bottom Line: Facet nerve block was found to be a simple, minimally invasive, and safe procedure.With meticulous patient selection, we achieved long-term success rates of over 60%.We conclude that this method represents an important alternative treatment for nonradicular back pain.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP).

Materials and methods: Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post-lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks.

Results: A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered.

Conclusions: Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain.

No MeSH data available.


Related in: MedlinePlus