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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

Facet injection in spondylolysis. The lateral radiograph (A) shows a break in the pars interarticularis (arrow). Oblique fluoroscopic spot image (B) shows a fluoroscopy-guided L4–5 facet injection with filling of the inferior recess (arrowhead). Note the spondylolysis (arrow). A more delayed image (C) shows tracking of contrast from the facet joint into the spondylolytic site (arrow). Note the emptying of contrast from the joint space.
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Figure 0007: Facet injection in spondylolysis. The lateral radiograph (A) shows a break in the pars interarticularis (arrow). Oblique fluoroscopic spot image (B) shows a fluoroscopy-guided L4–5 facet injection with filling of the inferior recess (arrowhead). Note the spondylolysis (arrow). A more delayed image (C) shows tracking of contrast from the facet joint into the spondylolytic site (arrow). Note the emptying of contrast from the joint space.

Mentions: Injections for spondylolysis are a modification of facetal injections, providing good response in most patients. Some workers feel that it is the fracture site which is painful and, accordingly, infiltrate the break in the pars interarticularis.[4] Others have demonstrated that injection of the adjacent facet joint also involves the spondylolytic area and the technique can thus be used for therapeutic injections.[1019] On fluoroscopy, we could demonstrate the passage of contrast from the facet joint into the defect in the pars interarticularis [Figure 7], with good and sustained pain relief. The uniformly poor results with facet joint injections in patients with FBSS is because post–lumbar surgery pain is due to an interplay of numerous causes and facet joint injection addresses only one of them.[1420] Due to the small number of FBSS patients in our series we could not derive any statistically significant information from our data.


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

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

Facet injection in spondylolysis. The lateral radiograph (A) shows a break in the pars interarticularis (arrow). Oblique fluoroscopic spot image (B) shows a fluoroscopy-guided L4–5 facet injection with filling of the inferior recess (arrowhead). Note the spondylolysis (arrow). A more delayed image (C) shows tracking of contrast from the facet joint into the spondylolytic site (arrow). Note the emptying of contrast from the joint space.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0007: Facet injection in spondylolysis. The lateral radiograph (A) shows a break in the pars interarticularis (arrow). Oblique fluoroscopic spot image (B) shows a fluoroscopy-guided L4–5 facet injection with filling of the inferior recess (arrowhead). Note the spondylolysis (arrow). A more delayed image (C) shows tracking of contrast from the facet joint into the spondylolytic site (arrow). Note the emptying of contrast from the joint space.
Mentions: Injections for spondylolysis are a modification of facetal injections, providing good response in most patients. Some workers feel that it is the fracture site which is painful and, accordingly, infiltrate the break in the pars interarticularis.[4] Others have demonstrated that injection of the adjacent facet joint also involves the spondylolytic area and the technique can thus be used for therapeutic injections.[1019] On fluoroscopy, we could demonstrate the passage of contrast from the facet joint into the defect in the pars interarticularis [Figure 7], with good and sustained pain relief. The uniformly poor results with facet joint injections in patients with FBSS is because post–lumbar surgery pain is due to an interplay of numerous causes and facet joint injection addresses only one of them.[1420] Due to the small number of FBSS patients in our series we could not derive any statistically significant information from our data.

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