[Treatment of lumbar facet joint syndrome by CT-guided infiltration of the intervertebral joints].
BACKGROUND
Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain. Denervation by scalpel or electrofrequency is a well-known method of treating it. An alternative method for longer lasting pain relief is CT-guided intraarticular infiltration of facet joints with local anaesthetics and cortisone.


METHODS
In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but had additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis.


RESULTS
Results were significantly in group 2 than in group 1 (Fisher's exact test P < 0.012). In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant (Table 3). Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded.


CONCLUSIONS
CT-guided facet joint infiltration is a good method for treatment and diagnosis of lumbar facet joint syndrome. It can be repeated and has no severe side effects. The best results were seen in patients with spondylarthrosis of the facet joints. After lumbar disc surgery the pain relief was shorter, though it also yielded good results. For patients with unspecific low back pain, facet joint injections are a very good diagnostic method, allowing definite exclusion of lumbar facet syndrome.
Schleifer
J
J
Radiologische Abteilung, Knappschaftsklinik Püttlingen/Saar.
Fenzl
G
G
Wolf
A
A
Diehl
K
K
D002045:Bupivacaine / Q000008:administration & dosage*; D017586:Diskectomy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007405:Intervertebral Disc Displacement / Q000601:surgery; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D014057:Tomography, X-Ray Computed
D008775:Methylprednisolone; D002045:Bupivacaine
Behandlung des lumbalen Facettensyndroms durch CT-gesteuerte Infiltration der Zwischenwirbelgelenke.