Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results. RFS Journal Primer

BOTTOM LINE

• Lumbar facet block is an excellent means of determining if a patients pain is due to facet arthropathy.Not only does it aid in diagnosis but when injected with anesthetic pain relieve can be achievedimmediately. Patients who had not undergone previous surgery had a better initial response andlonger improvement than those who had undergone laminectomy or spinal fusion.

MAJOR POINTS

• Fluoroscopic controlled intraarticular facet arthrography and block is a reliable technique fordiagnosing and treating low back pain due to lumbar facet syndrome.

• Facet joint distention by contrast material reproduces the patient’s pain, while instillation of thelocal anesthetic relieves it.

CRITICISM

• The biggest problem is the initial clinical determination of those patients who may have facet

syndrome and the decision as to which level(s) to inject.

Quick Summary

A Prospective analysis was completed

• 44 patients with acute or chronic back pain underwent facet block. 41 had no previous surgery. 13 had a previous laminectomy and or fusion.

INCLUSION CRITERIA

• Choice of injection level was based on clinical evidence, especially focal tenderness.

• If no focal tenderness was elicited L4-5 or L5-S1 was injected bilaterally.

EXCLUSION CRITERIA

• If there was no focal tenderness but osteoarthritis was present at a particular location but osteoarthritis was present at a level the level with osteoarthritis was injection.

Study design

• To determine if spinal facet injection is an adequate means of determining the location of facet pain and adequate means of treating it.

Purpose

• Facet joint injection is an excellent minimally invasive means of both diagnosing and treating lumbar facet arthropathy.

Intervention

Outcome

• Lumbar facet block is an excellent means of determining if a patients pain is due to facetarthropathy. Not only does it aid in diagnosis but when injected with anesthetic pain relievecan be achieved immediately. Patients who had not undergone previous surgery had a betterinitial response and longer improvement than those who had undergone laminectomy orspinal fusion. In 29 patients facet syndrome was diagnosed based upon the fact that theirsymptoms improved following facet block. Of these, 18 had temporary relief of symptoms, 11patients achieved long-term therapeutic benefit.

Credits

SUMMARY BY:

Michael Warren, M.D. R3 PGY4_Diagnostic Radiology

Providence Hospital and Medical Centers.

*FULL CITATION(S): Destouet, J. M., et al. "Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results." Radiology 145.2 (1982): 321-325.

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