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

Abdelghany Mohammed Motawea; Mohammed Ramadan El Kholy; Osama Mohamed Ebied; Waleed Abd El Fattah Mousa; Mohamed Shawky Abdullah

doi:doi:10.11648/j.ajhr.20150302.11

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

Abdelghany Mohammed Motawea, Mohammed Ramadan El Kholy, Osama Mohamed Ebied, Waleed Abd El Fattah Mousa, Mohamed Shawky Abdullah

Published in American Journal of Health Research (Volume 3, Issue 2)

Received: 30 September 2014 Accepted: 22 October 2014 Published: 16 February 2015

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

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.

Published in	American Journal of Health Research (Volume 3, Issue 2)
DOI	10.11648/j.ajhr.20150302.11
Page(s)	52-56
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Facetal Arthropathy, Facetal Infiltrations, Facetal Block, Low Back Pain

References

[1]	Cassidy JD, Côté P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30:2817–23.Chang HJ, Burke AE, Glass RM. Gliomas. JAMA 2010; 303(10):1000.
[2]	Manchikanti L, Singh V, Pampati V, Ghafoor AB, Fellows B, Damron KS, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician. 2001;4:308–16.
[3]	Pang WW, Mok MS, Lin ML, Chang DP, Hwang MH. Application of spinal pain mapping in the diagnosis of low back pain: Analysis of 104 cases. Acta Anaesthesiol Sin. 1998;36:71–74.
[4]	Silbergleit R, Mehta BA, Sanders WP, Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics. 2001;21:927–39.
[5]	Boswell MW, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.
[6]	Cavanaugh JM, Lu Y, Chen C, Kallakuri S. Pain generation in lumbar and cervical facet joints. J Bone Joint Surg Am. 2006;88:63–7.
[7]	Galloway H. Image-guided spinal injection for diagnosis and therapy. Australasian Radiology 2003; 47, 219–225.
[8]	Arti Chaturvedi, Sunil Chaturvedi, and Rajiv Sivasankar Image-guided lumbar facet joint infiltration in nonradicular low back pain Indian J Radiol Imaging. 2009 February; 19(1): 29–34.
[9]	Schwarzer AC, Wang S, O'Driscoll D, Harrington T, Bogduk N, Laurent R. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine. 1995;20:907–12.
[10]	Gilula LA, Lander P. Management of spinal pain with imaging-guided injection. Radiographics. 2003;23:189–91.
[11]	Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007;23:45–52.
[12]	Wagner AL. Paraspinal injections: Facet Joint and Nerve Root Blocks. Available at: http://www.emedicine.com/radio/topic884.htm, Accessed October 7, 2005.
[13]	Bani A, Spetzger U, and Gilsbach J. Indications for and benefits of lumbar facet joint block: analysis of 230 consecutive patients. Neurosurg. Focus 2002;13: 202-207.
[14]	Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7–111.
[15]	Gorbach C, Schmid MR, Elfering A, Hodler J, Boos N. Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol. 2006;186:1228–33.
[16]	Mannion AF, Balagué F, Pellisé F, Cedraschi C. Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol. 2007;3:610–8.
[17]	Destouet JM, Gilula LA, Murphy WA, Monsees B. Lumbar facet joint injection: Indications, technique, clinical correlation, and preliminary results. Radiology. 1982;145:321–5.
[18]	Lilius G, Harilainen A, Laasonen EM, Myllynen P. Chronic unilateral low-back pain: Predictors of outcome of facet joint injections. Spine. 1990;15:780–2.
[19]	Shih C, Lin GY, Yueh KC, Lin JJ. Lumbar zygapophyseal joint injections in patients with chronic lower back pain. J Chin Med Assoc. 2005;68:59–64.
[20]	Schulte TL, Pietila TA, Heidenreich J, Brock M, Stendel R. Injection therapy of lumbar facet syndrome: A prospective study. Acta Neurochir (Wien) 2006;148:1165–72.
[21]	el-Khoury GY, Renfrew DL. Percutaneous procedures for the diagnosis and treatment of lower back pain: Diskography, facet joint injection, and epidural injection. AJR Am J Roentgenol. 1991;157:685–91.
[22]	Wilkinson HA. In the failed back syndrome.etiology and therapy. 2nd ed. New York: Springer-Verlag; 1992. Introduction: Etiology, diagnosis, and therapy; pp. 1–3.
[23]	Windsor RE, Pinzon EG, Gore HC. Complications of common selective spinal injec¬tions: Prevention and management. Am J Orthop. 2000;29:759–70.
[24]	Nelemans PJ, deBie RA, deVet HC, Sturmans F. Injection therapy for subacute and chronic benign low back pain. Spine. 2001;26:501–15.
[25]	Magee M, Kannangara S, Dennien B, Lonergan R, Emmett L, Van der Wall H. Paraspinal abscess complicating facet joint injection. Clin Nucl Med. 2000;25:71–3.
[26]	Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med. 2006;7:52–6.

Cite This Article

Plain Text BibTeX RIS

APA Style

Abdelghany Mohammed Motawea, Mohammed Ramadan El Kholy, Osama Mohamed Ebied, Waleed Abd El Fattah Mousa, Mohamed Shawky Abdullah. (2015). Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. American Journal of Health Research, 3(2), 52-56. https://doi.org/10.11648/j.ajhr.20150302.11

Copy | Download

ACS Style

Abdelghany Mohammed Motawea; Mohammed Ramadan El Kholy; Osama Mohamed Ebied; Waleed Abd El Fattah Mousa; Mohamed Shawky Abdullah. Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. Am. J. Health Res. 2015, 3(2), 52-56. doi: 10.11648/j.ajhr.20150302.11

Copy | Download

AMA Style

Abdelghany Mohammed Motawea, Mohammed Ramadan El Kholy, Osama Mohamed Ebied, Waleed Abd El Fattah Mousa, Mohamed Shawky Abdullah. Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. Am J Health Res. 2015;3(2):52-56. doi: 10.11648/j.ajhr.20150302.11

Copy | Download

@article{10.11648/j.ajhr.20150302.11,
  author = {Abdelghany Mohammed Motawea and Mohammed Ramadan El Kholy and Osama Mohamed Ebied and Waleed Abd El Fattah Mousa and Mohamed Shawky Abdullah},
  title = {Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management},
  journal = {American Journal of Health Research},
  volume = {3},
  number = {2},
  pages = {52-56},
  doi = {10.11648/j.ajhr.20150302.11},
  url = {https://doi.org/10.11648/j.ajhr.20150302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20150302.11},
  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.},
 year = {2015}
}

Copy | Download

TY - JOUR
T1 - Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management
AU - Abdelghany Mohammed Motawea
AU - Mohammed Ramadan El Kholy
AU - Osama Mohamed Ebied
AU - Waleed Abd El Fattah Mousa
AU - Mohamed Shawky Abdullah
Y1 - 2015/02/16
PY - 2015
N1 - https://doi.org/10.11648/j.ajhr.20150302.11
DO - 10.11648/j.ajhr.20150302.11
T2 - American Journal of Health Research
JF - American Journal of Health Research
JO - American Journal of Health Research
SP - 52
EP - 56
PB - Science Publishing Group
SN - 2330-8796
UR - https://doi.org/10.11648/j.ajhr.20150302.11
AB - 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.
VL - 3
IS - 2
ER -

Copy | Download

Author Information

Abdelghany Mohammed Motawea

Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
Mohammed Ramadan El Kholy

Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
Osama Mohamed Ebied

Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
Waleed Abd El Fattah Mousa

Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
Mohamed Shawky Abdullah

Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Abdelghany Mohammed Motawea, Mohammed Ramadan El Kholy, Osama Mohamed Ebied, Waleed Abd El Fattah Mousa, Mohamed Shawky Abdullah. (2015). Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. American Journal of Health Research, 3(2), 52-56. https://doi.org/10.11648/j.ajhr.20150302.11

Copy | Download

ACS Style

Abdelghany Mohammed Motawea; Mohammed Ramadan El Kholy; Osama Mohamed Ebied; Waleed Abd El Fattah Mousa; Mohamed Shawky Abdullah. Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. Am. J. Health Res. 2015, 3(2), 52-56. doi: 10.11648/j.ajhr.20150302.11

Copy | Download

AMA Style

Abdelghany Mohammed Motawea, Mohammed Ramadan El Kholy, Osama Mohamed Ebied, Waleed Abd El Fattah Mousa, Mohamed Shawky Abdullah. Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management. Am J Health Res. 2015;3(2):52-56. doi: 10.11648/j.ajhr.20150302.11

Copy | Download

@article{10.11648/j.ajhr.20150302.11,
  author = {Abdelghany Mohammed Motawea and Mohammed Ramadan El Kholy and Osama Mohamed Ebied and Waleed Abd El Fattah Mousa and Mohamed Shawky Abdullah},
  title = {Imaging- Guided Facet Joint Injection Technique for Lower Back Pain Management},
  journal = {American Journal of Health Research},
  volume = {3},
  number = {2},
  pages = {52-56},
  doi = {10.11648/j.ajhr.20150302.11},
  url = {https://doi.org/10.11648/j.ajhr.20150302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20150302.11},
  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.},
 year = {2015}
}

Copy | Download