Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management

Abstract

Objectives: This study aimed to evaluate the role of image-guided lumbar facet joint injection in lower back pain. Background: With the increased lifetime prevalence of spinal pain and the realization by surgeons that not all backache is a ‘disc’ and not all patients with LBP will respond to surgery, there is increasing awareness of the role of percutaneous injection techniques in the nonoperative management of chronic LBP. The use of image-guidance with fluoroscopy or CT scan has increased the precision and safety of these procedures. Methods: Fifty patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. Facet joint injections were carried out under fluoroscopic guidance in 38 patients and under CT guidance in 12 cases. Pain relief was assessed using the visual analog scale at 4, 12, and 24 weeks post-procedure. These results were compared to a control group (n=25) which were subjected to medical treatment. Results: A total of 146 facet joints were infiltrated in 50 patients over a 2-year period. There was significant pain relief in 88% after 4 weeks, in 92% after 12 weeks, and in 64% after 24 weeks. No major complications were encountered. The control group which was subjected to medical treatment showed pain relief in 40% after 4 weeks, in 32% after 12 weeks, and in 28% after 24 weeks with less pain relief in comparison to the injected group. Conclusion: With intraarticular facet joint injections, the evidence for short- and medium-term pain relief is successful for lumbar pain in comparison to medical treatment. Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With precise patient selection, we achieved long-term success rates of over 60% after 24 weeks. We conclude that this method represents an important alternative treatment for nonradicular back pain.