CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2009; 19(01): 29-34
DOI: 10.4103/0971-3026.44522
VASCULAR & INTERVENTIONAL

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

Arti Chaturvedi
Department of Radiodiagnosis, Command Hospital, Air Force, Bangalore, India
,
Sunil Chaturvedi
Department of Anesthesia and Pain Medicine, Command Hospital, Air Force, Bangalore, India
,
Rajiv Sivasankar
Department of Radiodiagnosis, Command Hospital, Air Force, Bangalore, India
› Author Affiliations

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.



Publication History

Article published online:
31 July 2021

© 2009. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Cassidy JD, Cτtι P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine 2005;30:2817-23.
  • 2 Manchikanti L, Singh V, Pampati V, Ghafoor AB, Fellows B, Damron KS, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician 2001;4:308-16.
  • 3 Pang WW, Mok MS, Lin ML, Chang DP, Hwang MH. Application of spinal pain mapping in the diagnosis of low back pain: Analysis of 104 cases. Acta Anaesthesiol Sin 1998;36:71-74.
  • 4 Silbergleit R, Mehta BA, Sanders WP, Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics 2001;21:927-39.
  • 5 Boswell MW, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician 2007;10:229-53.
  • 6 Cavanaugh JM, Lu Y, Chen C, Kallakuri S. Pain generation in lumbar and cervical facet joints. J Bone Joint Surg Am 2006;88:63-7.
  • 7 Boswell MV, Shah RV, Everett CR, Sehgal N, Mckenzie-Brown AM, Abdi S, et al. Interventional techniques in the management of chronic spinal pain: Evidence-based practice guidelines. Pain Physician 2005;8:1-47.
  • 8 Schwarzer AC, Wang S, O′Driscoll D, Harrington T, Bogduk N, Laurent R. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine 1995;20:907-12.
  • 9 Gilula LA, Lander P. Management of spinal pain with imaging-guided injection. Radiographics 2003;23:189-91.
  • 10 Destouet JM, Gilula LA, Murphy WA, Monsees B. Lumbar facet joint injection: Indications, technique, clinical correlation, and preliminary results. Radiology 1982;145:321-5.
  • 11 Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007;10:7-111.
  • 12 Gorbach C, Schmid MR, Elfering A, Hodler J, Boos N. Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol 2006;186:1228-33.
  • 13 Mannion AF, Balaguι F, Pellisι F,Cedraschi C. Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 2007;3:610-8.
  • 14 Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain 2007;23:45-52.
  • 15 Lilius G, Harilainen A, Laasonen EM, Myllynen P. Chronic unilateral low-back pain: Predictors of outcome of facet joint injections. Spine 1990;15:780-2.
  • 16 Nelemans PJ, deBie RA, deVet HC, Sturmans F. Injection therapy for subacute and chronic benign low back pain. Spine 2001;26:501-15.
  • 17 Shih C, Lin GY, Yueh KC, Lin JJ. Lumbar zygapophyseal joint injections in patients with chronic lower back pain. J Chin Med Assoc 2005;68:59-64.
  • 18 Schulte TL, Pietila TA, Heidenreich J, Brock M, Stendel R. Injection therapy of lumbar facet syndrome: A prospective study. Acta Neurochir (Wien) 2006;148:1165-72.
  • 19 el-Khoury GY, Renfrew DL. Percutaneous procedures for the diagnosis and treatment of lower back pain: Diskography, facet joint injection, and epidural injection. AJR Am J Roentgenol 1991;157:685-91.
  • 20 Wilkinson HA. Introduction: Etiology, diagnosis, and therapy. In the failed back syndrome. etiology and therapy. 2nd ed. New York: Springer-Verlag; 1992. p. 1-3.
  • 21 Windsor RE, Pinzon EG, Gore HC. Compli�cations of common selective spinal injec�tions: Prevention and management. Am J Orthop 2000;29:759-70.
  • 22 Magee M, Kannangara S, Dennien B, Lonergan R, Emmett L, Van der Wall H. Paraspinal abscess complicating facet joint injection. Clin Nucl Med 2000;25:71-3.
  • 23 Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med 2006;7:52-6.
  • 24 Berrigan T. Chemical meningism after lumbar facet joint block. Anesthesia 1992;47:905-6.