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Fluoroscopy-guided Intra-articular Facet Joint Steroid Injection for Management of Low Back Pain: Therapeutic effectiveness and arthrographic pattern 2011

General Spine

Sujin, Kim, DR
Joon Woo, Lee, Dr, Non ASSR Member
Heung Sik, Kang, Dr, Non ASSR Member
Mi Sook, Sung, Dr, Non ASSR Member
Guen Young, Lee, Dr, Non ASSR Member
Ji Young, Hwang, Dr, Non ASSR Member

Paper/Non-Mentor

Purpose

The purpose of this study was to evaluate the success rate and effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, as well as to document the incidence of epidural leakage, by a retrospective review of medical records and fluoroscopic arthrograms.

Methods & Materials

All patients had undergone intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain) in January 2010. Fluoroscopic arthrograms of intra-articular facet joint steroid injections were retrospectively analyzed by two radiologists in consensus.

Results

In total, 320 facet joint injections of 244 consecutive patients (187 women, 57men; mean age, 68.2 + 11.3 years) were included in this study. Of the 244 patients, 85.2 % (n=208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.8 % (n=162) of the patients showed symptom recurrence, with 69 days of median symptom-free interval, while 30.3 % (n = 74) of the patients showed symptom-free intervals of more than six months. The success rate of intra-articular injection was 100% under fluoroscopic guidance. Overall, 74 cases (33.3 %) of 222 intra-articular facet joint steroid injections showed epidural leakage in fluoroscopic arthrograms.

Conclusion

Fluoroscopy-guided intra-articular facet joint injection is a reliable and easy technique for the management of low back pain, with excellent short-term and good long-term results. Epidural leakage during intra-articular facet joint injection was detected in approximately one-third of the cases.

References/Financial Disclosures

This study is supported by grant no 02-2010-034 from the SNUBH Research Fund.