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

Destouet, J M; Gilula, Louis A.; Murphy, William A.; Monsees, Barbara

doi:10.1148/radiology.145.2.6215674

Cited by 164 publications

(71 citation statements)

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“…The usual findings include hypertrophy and osteophyte formation at the facet joints, subchondral sclerosis, cartilage narrowing and erosions at the facets (3,4). The distinction between disc herniation and facet joint arthropathy is important because it is possible to treat the facet joints with corticosteroid injections (6).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

Fagerlund

Thelander²

1989

Acta Radiol

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The results of lumbar myelography and computed tomography (CT) were compared in 51 consecutive patients with clinically suggested lumbar disc herniation. A total of 100 intervertebral levels were examined. At 62 levels, either L4/L5 or L5/S I, myelography was normal. CT showed no pathologic changes at 55 levels. The results concurred between myelography and CT in 89 per cent of the patients with normal findings. Four cases of disc herniation and one bulging disc, which had been missed at myelography because of a large epidural space at L5/S I, were picked up by CT. Two of these were verified by surgery and two were treated conservatively. There was one possible false negative case with CT as well. Abnormalities were shown at 38 intervertebrallevels, 22 in the bulging and 16 in the herniated disc group. The pathologic changes concurred in 84 per cent between the two investigations. For intervertebral disc herniation the true negative rate was, for myelography 88 per cent and for CT 97 per cent. The treatment strategy could have been based on CT alone at 37 out of 38 levels (97%), and on myelography alone at 34 out of 38 levels (89%). Furthermore, at CT the imaging of soft tissues and intervertebral joints was superior to that at myelography. It is concluded that CT should be the primary examination method of imaging for lumbar disc herniation. Myelography is, however, to be preferred where the level of the lesion is clinically unclear or when the entire lumbar region and thoraco-lumbar junction are to be examined.

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Section: Discussionmentioning

confidence: 99%

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

Fagerlund

Thelander²

1989

Acta Radiol

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“…The long-term (6 months) relief of back pain ranges from 18 % to 63 % in uncontrolled studies (Destouet et al 1982;Carrera and Williams 1984;Lippitt 1984;Raymond and Dumas 1984;Lewinnek and Warfield 1986;Murtagh 1988;Carette et al 1991;Long et al 1996). Others have not found any significant pain relief (Lilius et al 1989).…”

Section: Treatmentmentioning

confidence: 99%

“…The prevalence rate varies widely from 5 % to as much as 90 % in the literature (Carrera 1980;Destouet et al 1982;Raymond and Dumas 1984;Lau et al 1985;Lewinnek and Warfield 1986;Moran et al 1988;Murtagh 1988;Long et al 1996). However, recent studies with precise indications and methods have come to the conclusion that facet joint pain is the cause of 15 % of chronic low back pain (Jackson et al 1988;Murtagh 1988;Dreyer and Dreyfuss 1996;Newton et al 1997;Manchikanti et al 1999;Dreyfuss et al 2003;Sowa 2005).…”

Section: Facet Joint Syndromementioning

confidence: 99%

Thoracolumbar Injuries in Pediatric Athletes: Diagnosis, Treatment, Rehabilitation, and Prevention

Baranto

2015

Sports Injuries

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“…Long-term therapeutic benefit has been reported with injection of corticosteroids [24,[28][29][30][31]38], local anesthetics [28,53], or normal saline [5••,28,34,39] into the facet joints. Whereas the literature describing effectiveness of this intervention is abundant, only six randomized clinical trials (RCTs) offer data on the use of intra-articular injection in the lumbar spine, while it is limited with only one RCT on the cervical spine.…”

Section: Intra-articular Injectionsmentioning

confidence: 99%

“…In open, uncontrolled clinical studies, long-term relief defined as more than 6 months of lumbar and lower extremity pain from intra-articular injection of steroids ranged from 18% to 62% of patients [1, 16,24,27,[29][30][31]38]. In other studies, success rates were even lower than 18%.…”

Section: Intra-articular Injectionsmentioning

confidence: 99%

Facet joint pain and the role of neural blockade in its management

Manchikanti

1999

Current Review of Pain

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Chronic spinal pain is a common medical problem with serious financial and social consequences. Among the various structures with potential for producing pain in the spine, facet joints as sources of chronic spinal pain have attracted considerable attention and controversy. Significant progress has been made in precision diagnosis of spinal pain with neural blockade, in the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies. Research into the role of facet joints in spinal pain has shown that cervical facet joints are the cause of chronic neck pain in 54% to 60% of patients, whereas lumbar facet joints cause pain in 15% to 40% of patients with chronic low back pain. Local anesthetic blocks of medial branches have proven to be a reliable diagnostic test; they are target-specific when used appropriately with control blocks, either with two local anesthetics with different durations of action or with the addition of an inactive placebo injection. The literature is replete with reports on uncontrolled studies, case reports, and documentation from a few controlled studies, all of which offer supporting information on the rationale and effectiveness of facet blocks and neurotomy. Facet joint injections and medial branch blocks are considered to be of equal value. Lumbar intra-articular steroid injections have been proven effective to a certain extent, but evidence indicates that cervical intra-articular steroids are ineffective. The role of repeat medial branch blocks is not known. Radiofrequency neurotomy remains the only practical and validated treatment for cervical facet joint pain; however, its role in management of either lumbar or thoracic facet joint pain awaits validation.

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

Cited by 164 publications

References 0 publications

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

Thoracolumbar Injuries in Pediatric Athletes: Diagnosis, Treatment, Rehabilitation, and Prevention

Facet joint pain and the role of neural blockade in its management

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