Lumbar Facet Joint Injections: Is CT Guided Intra-Articular Needle Position Advantageous?
|Lilach Goldstein1, Karin Ariche2, Elon Eisenberg2,3*, Roi Treister4,3 and Rimma Geller2,5|
|1Department of Neurology, Rabin Medical Center, Campus Beilinson, Petach Tikva, Israel|
|2Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel|
|3The Technion, Israel Institute of Technology, Haifa, Israel|
|4Nerve Injury Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, USA|
|5Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel|
|Corresponding Author :||Elon Eisenberg
Institute of Pain Medicine
Rambam Health Care Campus, Haifa
Israel Haifa 31096, Israel
E-mail: [email protected]
|Received December 20, 2014; Accepted March 16, 2015; Published March 19, 2015|
|Citation: Goldstein L, Ariche K, Eisenberg E, Roi Treister R, Geller R (2015) Lumbar Facet Joint Injections: Is CT Guided Intra-Articular Needle Position Advantageous?. J Pain Relief 4:178. doi: 10.4172/2167-0846.1000178|
|Copyright: © 2015 Goldstein L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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.