Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

STUDY DESIGN: Level III, retrospective studies. OBJECTIVES: This study is conducted to evaluate the effect and usefulness of ultrasound guided facet block for the outpatients who complained of chronic lower back pain. SUMMARY OF THE LITERATURE REVIEW: Facet joint syndrome was introduced in 1976, by Mooney V. It was considered to be one of the major causes of low back pain. MATERIALS AND METHODS: Between October 2009 to March 2011, 98 cases were selected from the outpatients who complained of chronic lower back pain for more than 3 months. The patients had no surgery history and did not complain of neuromuscular symptoms, and they had more than three times outpatient care at least and could be followed up for 1 year. The patients were divided into three groups; first was the ultrasound guided facet block group (27 cases), second was the Fluoroscopy guided facet block group (39cases) and third was the conservative group (32 cases).The clinical results were analyzed using Kim's criteria and the Visual Analog Scale score, ODI score, Physician's global assessment (subjective), Patient's global assessment (Objective). RESULTS: The VAS score was improved from an average of 7.75+/-1.5 to 4.47+/-2.4 in the ultrasound guided facet block group, and from 7.81+/-1.4 to 4.39+/-2.6 in the Fluoroscopy guided facet block group, and from 7.87+/-1.3 to 6.24+/-2.1 in the conservative group. The VAS score, Kim's criteria, ODI score, Physician's global assessment (subjective), and Patient's global assessment (Objective) showed statistically significant improvement in the ultrasound guided facet block group and Fluoroscopy guided facet block group. CONCLUSION: In the outpatient clinics, comparing with the group that underwent conservative treatment with medication, the group treated with ultrasound for block could have better results in clinical improvement.

Clinical Effect of The Lumbar Facet Joint Arthrography and Injection for Facet Joint Syndrome

STUDY DESIGN: Intra-articular injections of long acting steriod and local anesthetics after lumbar facet joint(LFJ) arthrography are routinely used for therapeutic purposes in selected patients for relief of chronic low back pain. However, because of the difficulty in finding an accurate position of the symptomatic joint, the possibility of complication and the placebo effect, there are doubts about the clinical application of this treatment. OBJECTIVES: This study was designed to assess the diagnostic value and clinical benefits of lumbar facet joint arthrogram & injection of long acting steriod and local anesthetics in patients with facet joint syndrome. SUMMARY OF LITERATURE REVIEW: The radiological relationship and the diagnostic elements of facet joint syndrome need to be analyzed and evaluated for increasing the effectiveness of lumbar injection. MATERIALS AND METHODS: Fifty two patients with low back pain were enrolled in the trial and they met the following criteria: pain for more than 3 months, no root signs and no history of back surgery. The response to facet joint injection was analyzed according to the chief complaints, a provocative test, the Visual Analogue Scale(VAS), the Helbig & Lee(HL) score, the facet block procedure and the arthrogram findings. A questionnaire with a pain scale was administered immediately or the day after injection, and then after 1, 3, 6 and 12 weeks. The arthrograms were reviewed by a radiologist & orthopedic specialist. RESULTS: One hundred sixty nine joint injections were performed in 52 patients (L 3-4, n=33; L4-5, n=64; L5-S1, n=72). Thirty one patients had a chief complain of back pain that was aggravated by extension/rotation of the trunk and the provocative test was positive in 73.1%. The rates of a good response in the study group were 69.2% after one day, 44.2% after 3 weeks and 36.5% after 12 months. Arthrograms revealed synovial cysts in 1 of these patients and 5 patients had abnormal communication with spondylolysis. Two patients had contrast extravasated into the epidural space during injection. CONCLUSIONS: Lumbar arthrography showed a low diagnostic value. Lumbar injections, as a useful procedure to diagnosis facet joint syndrome, could be a useful palliative treatment modality for treating chronic lower back pain. But strict diagnostic criteria through a scoring system is needed to achieve a higher degree of predictability and effectiveness of facet joint injection.

Effectiveness of Facet Joint Injection for Treatment of Acute Osteoporotic Vertebral Compression Fracture / 대한골다공증학회지

OBJECTIVES: To evaluate the effectiveness of facet joint injection for acute phase of osteoporotic vertebral compression fracture as alternative method for vertebrolplasty. MATERIALS AND METHODS: From January 2001 to May 2007, a total 275 patient of osteoporotic vertebral compression fracture treated with conservative treatment or facet joint injection were selected. We divided all patients into two groups as treated only conservative treatment or facet joint injection. RESULTS: In comparison, group of patient who took facet joint injection showed significantly increased effects than the other group in pain, using pain controller and activity (P<0.05). Group of patient who took conservative treatment, are treated with vertebroplasty in 52 patients, are showed the loss of height in vertevral body in 4 patients. Group of patient who took facet joint injection, are treated with vertebroplasty in 43 patients, are showed the loss of height in vertevral body in 29 patients. There was no complication with facet joint injection or vertebroplasty. CONCLUSIONS: Facet joint injection is the effective and stable technique for acute pain on acute osteoporotic vertebral compression fracture. The loss of height in vertevral body is more frequent at group of patient who took facet joint injection.

Comparison of Ultrasonography- and Fluoroscopy-Guided Facet Joint Block in the Lumbar Spine

STUDY DESIGN: Retrospective study. PURPOSE: Facet joint block is performed for diagnostic or therapeutic purposes and generally carried out under computerd tomography (CT) or radiologic fluoroscopy guidance. Ultrasonography-guided facet block has recently been attempted. So, we compared the results of ultrasonography-guided facet joint block with the results of fluoroscopy-guided facet joint block. OVERVIEW OF LITERATURE: Because fluoroscopic or CT guided facet joint block has been reported side effects, we performed spinal facet block using a fluoroscopy-guided method. METHODS: We selected 133 patients who had lumbar pain or referred pain. They were diagnosed as having spinal stenosis and hospitalized from January 2008 to June 2008. As the subjects, we selected 105 patients who had been follow-up for more than 6 months and carried out a prospective study. RESULTS: The procedure in group 2 averaged 4 minutes and 25 seconds, and in group 1, 4 minutes and 7 seconds. The coast was an average of 38,000 won in group 2 and 25,000 won in group 1. The VAS score was improved from an average of 7.5 (range, 5 to 9) to 2.8 (range, 2 to 6) in group 2 and from 7.8 (range, 4 to 10) to 2.7 (range, 2 to 5) in group 1. The Oswestry disability index was improved from an average of 32.3 (range, 28 to 41) to 23.5 (range, 17 to 26) in group 2 and from 34.2 (range, 29 to 43) to 24.8 (range, 18 to 28) in group 1. As for complications, worsening of lumbar pain, paresthesia, headache and allergic reaction were detected in 5 cases of group 2 and in 3 of group 1. Those symptoms were improved within several hours. One case of superficial infection that developed in group 2 was improved within several days. CONCLUSIONS: We should consider that ultrasonography-guided facet joint block is a minimal invasive procedure that is easily carried out without radiation exposure.

Sudden Cardiac Arrest Following Cervical Facet Joint Injection: A case report / 대한마취과학회지

The common disorder called facet syndrome exhibits back pain, with or without referred or radiating pain due to facet joint arthropathy. Facet joint injection using local anesthetics is a reliable method for the diagnosis and treatment for facet syndrome. Because the complications secondary to facet block have usually been temporary and infrequent, facet block has been known as a simple and safe procedure. But spinal anesthesia is a serious complication of facet block and can lead to a life threatening conditions. The authors report a patient who developed un-explainable cardiac arrest following facet joint injection. A 64 year-old woman with 4-year history of cervical facet syndrome was admitted for the fourth facet block. Cardiac arrest followed with unconsciousness and apnea occurred 4 minutes after cervical facet joint injection with 2 ml of 2% lidocaine. The patient was immediately resuscitated and recovered without any sequelae. Sudden cardiac arrest can be unexpectedly developed during facet block, and we recommend close monitoring during cervical facet joint block.

Percutaneous Vertebroplasty and Facet Joint Block

It is surprising that about 24% of patients with benign osteoporotic vertebral fracture die within a year from respiratory infection and urinary tract infection because of coughing and voiding difficulties, depending on the sites of compression fractures. We reviewed 500 patients on whom percutaneous vertebroplasty (PVP) was performed, at 612 levels in terms of patient selection, operation technique, medication, and clinical outcomes during the follow-up course for 2 yr study period. To confirm the most painful level among the multiple fracture sites, physical examination after facet joint block under the fluoroscope was the most reliable method. The mean total lumbar spine fracture threshold of bone mineral density was 0.81+/-0.05 g/cm2. The mean changes of numeric rating scale scores, Oswestry Disability Index except sex life, and Karnofsky performance status were -72.00, -83.50 and +60.62% in the osteoporosis group and -51.89, -45.02, and 69.03% in the tumor group. Complications related to the procedure were lateral spinal cord damage, transient paresthesia and transient hypotension. PVP with facet joint block is a profitable method for the vertebral compression fracture because of low risk and short duration of procedure with a high chance to result in pain relief and early mobilization.

Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults

OBJECTIVE: To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. METHOD: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). RESULTS: The lower lumbar spine revealed the longer SFL (p0.05). There was no correlation with height and weight, either (r<0.04). CONCLUSION: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints.