title: Lumbar zygapophyseal joint injections in patients with chronic lower back pain.
abstract: BACKGROUND
  This study was designed to assess the diagnostic value and clinical benefits of lumbar zygapophyseal joint injections in patients with chronic lower back pain.
  
  
  METHODS
  Two hundred and seventy-seven patients (136 males and 141 females, aged 15-82 years) with chronic lower back pain were enrolled in the trial and met the following criteria: pain for more than 1 year; no root signs; and no history of back surgery. Under fluoroscope, a 0.8-1.5 mL mixture of lidocaine, betamethasone dipropionate and iopamidol (1:1:0.5) was injected into each joint after intra-articular localization of the needle tip was confirmed. A questionnaire with a pain scale was administered immediately or the day after injection, and then after 1, 3, 6 and 12 weeks. Partial arthrograms were reviewed by a radiologist.
  
  
  RESULTS
  Four hundred and forty-nine joint injections were performed in 277 patients (L3-4, n = 76; L4-5, n = 272; L5-S1, n = 101). Bilateral injections were performed in 117 patients (42.2%). The study group comprised 204 patients (73.6%) with an excellent or good response, whereas the control group comprised the remaining 73 patients (26.4%). The rates of good response in the study group were 72.1% (147/204) after 3 weeks, 40.7% (83/204) after 6 weeks, and 31.4% (64/204) after 12 weeks. Partial arthrograms revealed 25 patients (9.0%) with synovial cysts (L3-4, n = 3; L4-5, n = 14; L5-S1, n = 8); 23 of these patients (92.0%) had a good response to the injections. Five of the 6 patients with spondylolysis (83.3%), having abnormal communication between the injected and contiguous joint, had a good response to the injections. The abovementioned, abnormal partial-arthrogram findings correlated significantly with the rate of good response to the injections. Although 3 patients had contrast medium extravasated into the epidural space during injection, none of the 277 patients had deteriorating lower back pain after the injections.
  
  
  CONCLUSIONS
  Lumbar zygapophyseal joint injections, as a useful diagnostic tool for facet joint syndrome, could also have useful palliative effects in the management of chronic lower back pain.
authors.affiliation: Department of Radiology, Chu-Shang Show-Chwan Hospital, Nantou, Taiwan, R.O.C. chunhsi_shih@yahoo.com.tw
authors.forename: Chunhsi
authors.initials: C
authors.lastname: Shih
authors.forename: Gin-Yau
authors.initials: GY
authors.lastname: Lin
authors.forename: Kuo-Chu
authors.initials: KC
authors.lastname: Yueh
authors.forename: Juei-Jueng
authors.initials: JJ
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography / Q000379:methods; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002908:Chronic Disease; D004338:Drug Combinations; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007267:Injections; D007479:Iopamidol / Q000008:administration & dosage / Q000627:therapeutic use; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*
chemical_list: D004338:Drug Combinations; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D008012:Lidocaine; D007479:Iopamidol