Efficacy of ultrasonography-guided injections in patients with facet syndrome of the low lumbar spine

Abstract

Objective: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections.

Method: Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure.

Results: Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p<0.05). However at a week, a month, and three months after injections, no significant differences were observed between the groups with regard to VAS, PhyGA, PaGA, and MODI (p>0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7±6.5 sec; US: 263.4±5.9 sec; p=0.023).

Conclusion: US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.

Keywords: Intraarticular injections; Low-back pain; Ultrasonography; Zygapophysial joint.

Fig. 1

L4-L5 spinous processes demonstrated in a posterior paravertebral parasagittal sonogram using ultrasonography.

Fig. 2

(A) Photograph showing the position of the ultrasonography transducer for examining the left L4-5 lumbar facet joint (B) Sonogram corresponding to the transducer position shown in (A). SP: Spinal process, MF: Medial facet, LF: Lateral facet, Big open arrow: Needle, Small open arrow: Joint space, Small closed arrow: Facet joint capsule.