Facet Joint Steroid Injection Research Articles

The positive prediction of single photon emission computed tomography/ computed tomography (SPECT/CT) in the outcome of intervention for cervical facet pain

BACKGROUND CONTEXTPrevious studies have reported that magnetic resonance imaging (MRI) and computed tomography (CT) do not predict response to facet blocks. However, single photon emission computed tomography (SPECT) uptake within facet joints has been shown to correlate with pain relief after intervention in the lumbar spine. There is minimal data regarding the predictive value of single photon emission computed tomography/computed tomography (SPECT/CT) for neck pain. PURPOSEThe aim of this study was to evaluate the utility of SPECT/CT in patients with axial neck pain for the identification of specific facet joints that would benefit from diagnostic and therapeutic facet joint steroid injections and/or medial branch block/RFA treatments. STUDY DESIGNA retrospective cohort study. PATIENT SAMPLEOne hundred seventy-nine patients at a single institution pain center with neck pain and a SPECT/CT scan between 2009 and 2015. One hundred twelve patients had no prior intervention at the level of interest and met inclusion criteria. OUTCOME MEASURESPain reduction at 50% and 80% thresholds within 24 hours of facet intervention. Concordance of facet intervention with the focus of maximal uptake on SPECT/CT scan. METHODSAll patients were referred to our institution's Center for Pain Medicine and were treated with facet interventions. The site of facet intervention was determined by pain center providers based on their clinical examination and interpretation of images. Groups were formed based on whether the facet intervention included the level of maximal uptake on SPECT/CT scan. A positive response to intervention was defined at both 50% and 80% thresholds for reduction in pain within 24 hours of facet injection with steroid and local anesthetic or medial branch block with local anesthetic only. These were the facet interventions used for our data collection. A Chi-square statistic was used to analyze categorical data and a Student's t-test was used to analyze non-categorical data. SPSS (IBM Corp. IBM SPSS Version 24.0) was used for all analyses. RESULTSOf our 112 patients, Group 1 consisted of 89 with an intervention occurring at the level with increased uptake on SPECT/CT. Group 2 consisted of 23 patients with an intervention at a level without uptake on SPECT/CT. Demographic data did not significantly differ between cohorts. A Chi-square test of independence demonstrated that intervention at a level concordant with SPECT/CT was significantly correlated with self-reported pain relief thresholds of both 50% and 80% (p=.0002). CONCLUSIONSFacet interventions based on SPECT/CT scan uptake were more successful in pain reduction than those which were not. This suggests a role for SPECT/CT in diagnosing therapeutic targets for neck pain. Level of Evidence3

Facet Joint Versus Transforaminal Epidural Steroid Injections in Patients With Cervical Radicular Pain due to Foraminal Stenosis: A Retrospective Comparative Study.

BackgroundA cervical transforaminal epidural (TFE) steroid injection is a useful treatment option for cervical radicular pain, but it carries a small risk of catastrophic complications. Several studies have reported that cervical facet joint (FJ) steroid injection can reduce cervical radicular pain through an indirect epidural spread. The aim of this retrospective comparative study was to evaluate the pain scores and functional disability in subjects receiving cervical FJ or TFE steroid injection for the treatment of cervical radicular pain due to foraminal stenosis (FS).MethodsWe selected 278 patients 18 years of age and older who underwent cervical FJ (n = 130) or TFE (n= 148) steroid injection for cervical radicular pain. The primary outcomes included pain scores and functional disability during hospital visits one, three, and six months after the initial injection. Secondary outcomes were the proportion of responders and Medication Quantification Scale (MQS) scores. Adverse events and variables correlating with effectiveness one month after the initial injection were also evaluated.ResultsThe Numeric Rating Scale and Neck Disability Index scores showed a significant improvement one, three, and six months after the initial injection in both groups, with no significant differences between the groups. No significant differences were observed in the success rates of the procedure one, three, and six months after the initial injection for either group. There were no significant differences in MQS between the groups during the follow-up period. Univariate and multivariate logistic regression analyses revealed that the injection method, age, sex, number of injections, FS severity, MQS, pain duration, and the presence of cervical disc herniation were not independent predictors of treatment success.ConclusionThe efficacy of FJ steroid injection may not be inferior to that of TFE steroid injection in patients with cervical radicular pain due to FS.

A Case of Migraine Headaches with Hemifacial Spasm: Complete Resolution of Hemifacial Spasm Following Upper Cervical Intraarticular Facet Joint Injection

Background: Headache is one of the leading neurological disorders both globally and nationally, responsible for significant morbidity and disability. Migraine headache disorder is a common headache disorder affecting at least 11% of world’s population. Case Report: We present a case of a patient who presented with migraine headaches associated with hemifacial spasm (only during acute migraine attacks) along with upper cervical pain. She was offered right-sided C2-C3 and C3-C4 intraarticular facet joint injections with steroid and local anesthetic under fluoroscopy. Significant relief in headaches along with a complete resolution of hemifacial spasms was noted. Conclusion: This outcome raises the possibility of underlying pathophysiological processes that could have been interrupted by cervical facet joint steroid injection to stop the facial spasms. To the best of our knowledge, this is the first case report of migraine headaches associated with hemifacial spasm that responded to cervical intraarticular facet joint injection. Key words: Facet joint injection, headache, hemifacial spasm, medial branch block, migraine, pathophysiology, spinal cord stimulation, trigeminocervical complex

Intra-articular facet joint steroid injection-related adverse events encountered during 11,980 procedures.

To analyze the incidence and characteristics of intra-articular facet joint injection (FJI)-related adverse events requiring hospitalization and emergency room visits. From January 2007 to December 2017, a total of 11,980 FJI procedures in 6066 patients (mean age 66.8 years, range 15-97 years, M:F = 2004:4062) were performed in our department. Of these, we retrospectively reviewed 489 cases in 432 patients who were hospitalized or visited the emergency room within a month of FJI. FJI-related adverse events were classified as procedure-related complications, drug-related systemic events, or uncertain etiology events, on the basis of consensus of two spine radiologists. This is a descriptive study without statistical analysis. There were 101 FJI-related adverse event cases in 99 patients (mean age 71.8 years, range 39-97 years, M:F = 39:60). The overall incidence of FJI-related adverse events was 0.84% (101/11,980) per case and 1.63% (99/6066) per patient. The incidence of procedure-related complications and drug-related systemic adverse events was 0.07% (8/11,980) and 0.15% (18/11,980), respectively; the rate of uncertain etiology events was 0.63% (75/11,980). All eight procedure-related complication cases involved major complications. There are seven cases of infectious spondylitis and one was progression of systemic aspergillosis to the spine. One patient died of an uncontrolled infection with infective endocarditis, and two patients experienced partial recovery with neurological sequelae. The overall incidence of FJI-related adverse events is low, and procedure-related major complications are rare without dural puncture or epidural hematoma. Nevertheless, infection can occur, resulting in serious outcomes. • The incidence of FJI-related adverse events requiring hospitalization or ER visit was 0.84%. • The incidence of major procedure-related complications was 0.07%. • All major complications were associated with infection and there were no cases of epidural hematoma.

Management of Nonsurgical Refractory Low Back Pain in the United States: A Retrospective Analysis

Abstract INTRODUCTION Low back pain (LBP) is the leading cause of disability worldwide. Patients with persistent LBP despite multiple interventions and who are ineligible for spine surgery are considered to have nonsurgical refractory back pain (NSRBP). We investigated the utilization of medications and nonpharmacologic therapies in this population in the United States. METHODS The IBM MarketScan® Research databases were used to identify adult patients with LBP diagnoses (excluding instability and nonmechanical etiologies) and a negative history of failed back surgery syndrome or spine surgery within the study period (2009-2016). Patients must have had medications prescribed within 2 wk of diagnosis or nonpharmacologic therapies for >30 d within the 3 to 24 mo following LBP diagnoses. The frequency of utilization of these therapies was calculated at 0 to 6, 6 to 12, and 12 to 24 mo postdiagnosis. RESULTS Among 55 945 patients, 69.8% of patients used nonpharmacologic therapy in the first 6 mo, 66.0% over the next 6 to 12 mo, and 78.7% in the second year. At all time points, the most-utilized therapies were chiropractic therapy, physical therapy (PT), and epidural or facet joint steroid injections. In the first 6 mo, 42.1% of patients saw a chiropractor, and 43.5% of patients attended PT; 13.6% of patients underwent ≥1 steroid injection. Over the next 6 mo, 38.5% of patients visited a chiropractor, 37.2% used PT, and 12.6% received ≥1 steroid injection. During the second year, 45.3% saw a chiropractor, 45.1% engaged PT, and 16.6% had ≥1 steroid injection. On average, 49.1% of patients used prescription pain medications over the 2 yr, most commonly opioids (40.5%), muscle relaxants (21.5%), and anticonvulsants (17.8%). CONCLUSION The majority of NSRBP patients used nonpharmacologic therapy, and almost half used prescription medications throughout the 2 yr. The most-utilized therapies were chiropractic therapy, PT, opioids, muscle relaxants, and anticonvulsants. Over 40% of patients engaged chiropractors or PT or used opioids.

Tertiary care hospital based study of outcome of facet joint triamcinolone injection in combination with lignocaine in chronic low back ache

Background: The objective of the study was to determine the effectiveness of facet joint triamcinolone steroid injection in combination with lignocaine in chronic low back ache by measuring the reduction of pain intensity.Methods: This descriptive study was conducted at the post graduate Department of Orthopedics, GMC Srinagar, Kashmir from June 2016 to September 2017. All patients with chronic low back ach (for three months or more) meeting the inclusion criteria were included. Pre pain was assessed using visual analog scale (VAS). Under image intensifier each facet joint was be infiltrated with a mixture containing 10 mg of steroid and 2 ml of 1% lidocaine. Follow ups were done at six weeks’ time and improvement was measured using the same grading system(VAS) to confirm the effectiveness of the procedure. Treatment was considered effective if the patient score below 4 on VAS after treatment with facet joint steroid injection.Results: In our study 100 patients with chronic low back ache were analyzed. The mean age was 56 years with SD ±22.91. The percentage of male patients were 52% while 46% were female. Mean duration of low back ache was 8 months with SD ±3.37. Facet joint steroid injection was efficacious in 67% patients and was ineffective in 33% patients.Conclusion: Facet joint steroid injection in combination with lignocaine is effective in reducing chronic backache and discomfort to the patients.

Efficacy of CT Guided Perineural and Facet Joint Steroid Injection in Patients with Chronic Spinal Pain

Efficacy of CT Guided Perineural and Facet Joint Steroid Injection in Patients with Chronic Spinal Pain

Effect of multiple cervical facet joint intra-articular steroid injection for early mobilization of cervical spine in early cervical predominant ankylosing spondylitis

Background: Ankylosing spondylitis (AS) have also been described as causes of facet joint pain. Image-guided injection of local anesthetic and steroid into the facet joint aims to break this vicious cycle and stop the inflammatory reaction involving facet joints in AS.Objectives: Image-guided injection of local anesthetic and steroid into the facet joint aims to break this vicious cycle and stop the inflammatory reaction involving facet joints in AS.Materials & Methods: Obtaining an informed consent, the procedure was performed with strict aseptic precautions and intra-procedural vital parameters were monitored.Results: After 7 days of extensive rehabilitation program, the ROM in all direction was dramatically improved with significant improvement of pain. Regarding VAS, during 1st visit it was 8, after 30 min of injection the score became 6 (25% improvement) and after one week, the score became 2 (75% improvement).Conclusion: Multiple intra-articular cervical facet joint steroid injection is very much effective in acute facet joint synovitis in cervical predominant early AS for starting early rehabilitation program.KYAMC Journal Vol. 9, No.-1, April 2018, Page 39-40

Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

Facet joint steroid injections are used to treat chronic low back pain. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections. The study cohort included 5 patients undergoing fluoroscopically guided intra-articular lumbar facet joint injections at a pain medicine specialty clinic. Blood was collected prior to the injections and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injections. The terminal elimination half-life of triamcinolone in a noncompartmental analysis was 213 hours. The peak median triamcinolone concentration of 3.6 ng/mL was detected within 24 hours after the injections. Serum cortisol levels were < 30 ng/mL for an average of 4.4 days. The maximum effect of triamcinolone on cortisol suppression was observed with triamcinolone serum levels of > 1.9 ng/mL. The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.

Efficacy and outcome predictors of fluoroscopy-guided facet joint injection for spondylolysis.

To assess the efficacy of fluoroscopy-guided facet joint injection for symptomatic spondylolysis and to analyze the outcome predictors. This study included 108 patients who underwent fluoroscopy-guided facet joint steroid injection for symptomatic spondylolysis with follow-up medical records from January 2013 to December 2016. Among them, 47 patients underwent concomitant epidural steroid injection. Response to injection was assessed at the initial follow-up. The symptom-free interval was analyzed using the Kaplan-Meier method. Outcome predictors were statistically analyzed using independent ttest and Chi-square test. The facet joint injection was effective in 52 of 108 (48.1%) patients at initial follow-up. Recurrence was reported in 21 of these 52 (40.4%) patients. For the 52 patients in whom facet joint injection was effective, the median symptom-free interval was 298days (95% confidence interval, 29-567days). No significant difference was found in the response between the group with facet joint injection only (n=61) and the group with facet joint injection and additional ESI (n=47). Additionally, no significant outcome predictors were detected. Fluoroscopy-guided facet joint injection may potentially be an effective therapy for providing prolonged pain relief and avoiding unnecessary surgery for symptomatic spondylolysis without significant outcome predictors.

Fluoroscopy-Guided Intra-Articular Facet Joint Steroid Injection for the Management of Low Back Pain: Therapeutic Effectiveness and Arthrographic Pattern

Facet joint pain is defined in a functional capacity as pain originating from a facet joint, and is a common cause of low back pain, with a prevalence rate ranging from 15% to 52% (1-4). Clinical symptoms and radiological findings related to facet joint syndrome are unreliable for the diagnosis of facet joint pain, so that the diagnosis “facet joint syndrome” is made clinically and by excluding other causes of low back pain (5, 6). Facet joint pain can be managed by nonsurgical interventions, including intra-articular facet joint steroid injections, medial branch blocks, neurolysis of medial branch nerves, and radiofrequency denervation of medial branch nerves. Of these interventions, intra-articular facet joint steroid injection is helpful Fluoroscopy-Guided Intra-Articular Facet Joint Steroid Injection for the Management of Low Back Pain: Therapeutic Effectiveness and Arthrographic Pattern 요통의 치료를 위한 투시하 척추후관절내 스테로이드 주사: 치료효과와 관절조영술 소견 중심으로

Clinical significance of postdecompression facet joint effusion after minimally invasive decompression for degenerative lumbar spinal stenosis.

A retrospective case series study. To investigate the clinical significance of postdecompression facet effusion (PDFE) after microendoscopic decompressive laminotomy (MEDL). The facet joint effusion noted on magnetic resonance imaging was considered as an indicator of degeneration of the facet joints and segmental instability. PDFE occurring after MEDL might imply postdecompression segmental instability. Its clinical significance has not yet been clarified. From 2005 to 2010, 165 patients with degenerative lumbar spinal stenosis (average age: 64.5, average follow-up: 25.8 mo) who received MEDL were reviewed. We investigated the incidence of PDFE with preoperative and repetitive magnetic resonance imaging at 6 months postoperatively. The clinical data and treatment courses were reviewed. The treatment outcomes were evaluated with Oswestry Disability Index and Japanese Orthopedic Association scores. The incidence of PDFE was 17.0% (n=28), which was significantly higher in patients receiving multilevel decompression and patients with scoliosis or spondylolisthesis. The intensity of low back pain was similar between patients with and without PDFE, but "mechanical" low back pain was only noted in patients with PDFE. Of the 28 patients with PDFE, only 9 symptomatic patients required invasive treatment (5 facet joint steroid injection, 3 revision MEDL, and 1 spinal fusion). Although the postoperative Oswestry Disability Index and Japanese Orthopedic Association scores were significantly worse these 9 patients, the final outcomes were good. Progression of spondylolisthesis was noted in 2 patients without PDFE but no patients with PDFE during the follow-up period. The relatively high incidence of PDFE after MEDL suggests that injury to the integrity of facet joint is inevitable during decompression of the stenosis, even using minimally invasive techniques. However, the overall stability is well preserved with very rare progression of spondylolisthesis. Most patients with PDFE are asymptomatic. The prognosis of PDFE is very good. Spinal fusion is rarely indicated.

Frequency of Discordance between Facet Joint Activity on Technetium Tc99m Methylene Diphosphonate SPECT/CT and Selection for Percutaneous Treatment at a Large Multispecialty Institution

The clinical impact of facet joint bone scan activity is not fully understood. The hypothesis of this study is that facet joints targeted for percutaneous treatment in clinical practice differ from those with reported activity on technetium Tc99m methylene diphosphonate SPECT/CT. All patients with a technetium Tc99m methylene diphosphonate SPECT/CT scan of the lumbar or cervical spine who underwent subsequent percutaneous facet joint steroid injection or comparative medial branch blocks at our institution between January 1, 2008, and February 19, 2013, were identified. Facet joints with increased activity were compared with those treated. A chart review characterized the clinical reasons for treatment discrepancies. Of 74 patients meeting inclusion criteria, 52 (70%) had discrepant imaging findings and treatment selection of at least 1 facet joint, whereas 34 patients (46%) had a side (right vs left) discrepancy. Only 92 (70%) of 132 facet joints with increased activity were treated, whereas 103 (53%) of 195 of treated facet joints did not have increased activity. The most commonly documented clinical rationale for discrepancy was facet joint activity that was not thought to correlate with clinical findings, cited in 18 (35%) of 52 patients. Facet joints undergoing targeted percutaneous treatment were frequently discordant with those demonstrating increased technetium Tc99m methylene diphosphonate activity identified by SPECT/CT at our institution, in many cases because the active facet joint(s) did not correlate with clinical findings. Further prospective double-blinded investigations of the clinical significance of facet joint activity by use of technetium Tc99m methylene diphosphonate SPECT/CT and comparative medial branch blocks are needed.

Lumbar facet joint injection: feasibility as an alternative method in high-risk patients

To evaluate the effectiveness of therapeutic facet joint steroid injections for symptoms caused by lumbar spinal stenosis in patients who are at risk of bleeding. We analysed 134 patients who had previously undergone one-level bilateral facet joint steroid injections for lumbar radiculopathy caused by spinal stenosis from January 2011 to December 2012. All patients had a bleeding tendency due to several medical conditions. A retrospective chart review was conducted by one radiologist. Response was measured by using a five-point patient satisfaction scale. Evaluations of the relationship between possible outcome predictors were made using the chi-squared or Fisher's exact test, as appropriate. Among the 42 enrolled patients (male/female = 14/28; mean age, 58 years; range, 41-88 years), 25 patients (59.5 %) were classified to have received effective treatment; in 17 patients treatment was classified as ineffective. Eighteen (72 %) of the 25 patients with mild-to-moderate central canal stenosis had symptom relief, and 7 of the 17 (41.2 %) patients with severe central canal stenosis had symptom relief (P < 0.05). Other outcome predictors were not statistically significant. Therapeutic facet joint steroid injection is potentially effective for lumbar radiculopathy caused by spinal stenosis. This could be helpful in patients at risk of bleeding. • Epidural injection of steroids is a conventional treatment for lumbar radiculopathy. • Facet joint steroid injections showed similar therapeutic effects in lumbar spinal stenosis. • No serious complications, including bleeding, occurred with facet joint injections. • Facet joint steroid injection offers an alternative therapy in patients with bleeding risk.

A Comparison of Intraarticular Lumbar Facet Joint Steroid Injections and Lumbar Facet Joint Radiofrequency Denervation in the Treatment of Low Back Pain

Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. In this study, we compared the effectiveness of intraarticular facet joint steroid injections and radiofrequency denervation. Our randomized, double-blind, controlled study included patients who received intraarticular steroid infiltrations in the lumbar facet joints (L3/L4-L5/S1) and patients who underwent radiofrequency denervation of L3/L4-L5/S1 segments. The inclusion criteria were based first on magnetic resonance imaging findings showing hypertrophy of the facet joints L3/L4-L5/S1 and a positive response to an intraarticular test infiltration of the facet joints L3/L4-L5/S1 with local anesthetics. The primary end point was the Roland-Morris Questionnaire. Secondary end points were the visual analog scale and the Oswestry Disability Index. All outcome assessments were performed at baseline and at 6 months. Fifty-six patients were randomized; 24 of 29 patients in the steroid injection group and 26 of 27 patients in the denervation group completed the 6-month follow-up. Pain relief and functional improvement were observed in both groups. There were no significant differences between the 2 groups for the primary end point (95% confidence interval [CI], -3 to 4) and for both secondary end points (95% CI for visual analog scale, -2 to 1; 95% CI for Oswestry Disability Index, -18 to 0). Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favorable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups.

Placebo response to interventional pain procedures and effect on patient outcome

Considerable debate exists over the effectiveness of numerous procedures performed in current interventional pain practice. Our goal was to review all current prospective, randomized, placebo-controlled trials pertaining to the most commonly performed interventional pain procedures and to present these results in the form of a comprehensive review article. A review of the literature was performed with extensive PubMed searches and no date restrictions. A review of various reference sections within articles was also done. All prospective, randomized, placebo-controlled trials acquired that pertained to the most commonly performed intervention pain medicine techniques were included in the review. Lumbar and transforaminal epidural steroid injections appear superior to placebo. Radiofrequency denervation and steroid injections for sacroiliac joint pain appear superior to placebo. Radiofrequency denervation for lumbar and cervical facetogenic pain appears superior to placebo. Intradiscal electrothermal therapy for discogenic low back pain may be more effective than placebo in a select group of patients. Alcohol neurolytic celiac plexus block appears superior to placebo in the treatment of pancreatic cancer pain. Current data do not support superiority over placebo for lumbar facet joint steroid injections, lumbar intradiscal steroid therapy, or vertebroplasty for treatment of osteoporotic fractures. A continued lack of prospective, randomized, placebo-controlled trials pertaining to interventional pain medicine still persists. The above results can only serve as a guide in current practice, as only tentative conclusions can be reached based on the current data.

Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients

Background context Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option. Purpose To profile the role of facet joint steroid injections with cyst rupture in the treatment of lumbar facet joint synovial cysts. Study design/setting Retrospective chart review and long-term follow-up of patients treated for lumbar facet joint synovial cysts. Patient sample One hundred one patients treated for lumbar facet joint synovial cysts with fluoroscopically guided corticosteroid facet joint injection and attempted cyst rupture. Outcome measures Oswestry Disability Index and numeric rating scale score for back and leg pain. Methods A retrospective review and a subsequent interview were conducted to collect pretreatment and posttreatment pain and disability scores along with details of subsequent treatment interventions. Group differences in pain and disability scores were assessed using paired t test. Multiple clinical factors were analyzed in terms of risk for surgical intervention using logistic regression modeling and Cox proportional hazards modeling. Results Successful cyst rupture was confirmed fluoroscopically in 81% of cases. Fifty-five patients (54%) required subsequent surgery over a period averaging 8.4 months because of inadequate symptom relief. All patients reported significant improvement in back pain, leg pain, and disability at 3.2 years postinjection, regardless of their subsequent treatment course (p<.0001 in all groups). There was no significant difference in current pain between patients who received injections only and those who underwent subsequent surgery. Conclusions This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.

Pitfalls of DXA interpretations in lumbar spines

Considerable debate exists over the effectiveness of numerous procedures performed in current interventional pain practice. Our goal was to review all current prospective, randomized, placebo-controlled trials pertaining to the most commonly performed interventional pain procedures and to present these results in the form of a comprehensive review article. A review of the literature was performed with extensive PubMed searches and no date restrictions. A review of various reference sections within articles was also done. All prospective, randomized, placebo-controlled trials acquired that pertained to the most commonly performed intervention pain medicine techniques were included in the review. Lumbar and transforaminal epidural steroid injections appear superior to placebo. Radiofrequency denervation and steroid injections for sacroiliac joint pain appear superior to placebo. Radiofrequency denervation for lumbar and cervical facetogenic pain appears superior to placebo. Intradiscal electrothermal therapy for discogenic low back pain may be more effective than placebo in a select group of patients. Alcohol neurolytic celiac plexus block appears superior to placebo in the treatment of pancreatic cancer pain. Current data do not support superiority over placebo for lumbar facet joint steroid injections, lumbar intradiscal steroid therapy, or vertebroplasty for treatment of osteoporotic fractures. A continued lack of prospective, randomized, placebo-controlled trials pertaining to interventional pain medicine still persists. The above results can only serve as a guide in current practice, as only tentative conclusions can be reached based on the current data.

Spondylodiscitis after facet joint steroid injection: A case report and review of the literature

Spondylodiscitis is a rare complication after facet joint steroid injection. This article presents a 78-y-old male with chronic back pain and facet joint arthritis who developed Pseudomonas aeruginosa L2-L3 and L3-L4 spondylodiscitis after computed tomography-guided facet joint steroid injection. Magnetic resonance imaging, fine needle aspiration and cultures confirmed the diagnosis. The patient was treated with intravenous administration of amikacin, and imipenem plus cilastatin for 4 weeks, followed by oral administration of ciprofloxacin for another 10 weeks. Sterile preparation prior to facet joint steroid injection should be stressed. To the best of our knowledge, this is the only reported case of iatrogenic spondylodiscitis after facet joint steroid injection. This iatrogenic complication should be considered in the risk-benefit analysis of facet joint diagnostic or therapeutic injections.