Lumbar Facet Joint Injections: Is CT Guided Intra-Articular Needle Position Advantageous?

Abstract

Background: Although facet joint injections of corticosteroids and local anesthetics are commonly performed for treating low back pain (LBP), their effectiveness remains questionable. This is partially due to lack of consensus regarding the correct needle-tip location within or nearby the facet joint. Purpose: The present study was designed to test if computerized tomography (CT) guided intra-articular needle position yields better results than peri-articular position of the needle, while performing lumbar facet joints injections for chronic LBP. Study Design/Setting: A prospective, randomized controlled trial conducted in A university hospital based pain clinic Patient sample: Forty-nine patients with chronic LBP related to facet joint arthropathy. Outcome measures: Scales of pain severity, analgesic drug consumption, lumbar motion, disability and patient's global impression of improvement. Methods: Patients were randomized to receive CT-guided intraarticular (n= 26) or periarticular (n=23) needle-tip positions during facet joint injections steroids and local anesthetics. Selection of the facet joint for injection was based on medical history, physical findings, CT scan, and bone scintigraphy. Patients were followed for eight weeks. Results: Although all outcome measures improved significantly from baseline throughout the entire follow-up period, none of them differed statistically or clinically between the two study groups. Conclusions: Facet joint injections of corticosteroids and local anesthetics provide short-term improvements in pain and disability in patients with chronic low back pain due to facet joints arthropathy. However, efforts to precisely locate the needle-tip within the facet joint – as oppose to perform a peri-articular injection - are not advantageous.