Injection therapy of lumbar facet syndrome: a prospective study.
BACKGROUND
Chronic low back pain remains a major health problem. Facet joint injection therapy is an easy to perform therapeutic option. However, few prospective studies use a standardized protocol to investigate injection therapy. The aim of our study was to evaluate quantity and duration of clinical improvement after this protocol, and to identify the best time for additional repetitive injection therapy.


METHODS
Thirty-nine patients (21 men, 18 women; mean age 55.2 years [range, 29-87 years]) with lumbar facet syndrome were treated with injection using a standardized protocol (prednisolone acetate, lidocaine 1%, phenol 5%) under fluoroscopic control. Follow-up was based on a specially designed questionnaire. Analysis included MacNab criteria, visual analogue scale, and pain disability index.


RESULTS
Reduction of pain was found up to 6 months after treatment. The outcome was assessed excellent or good by 62% (24 patients) of the patients after 1 month, by 41% (16 patients) after 3 months, and by 36% (14 patients) after 6 months. There was no influence of age, body mass index, or previous lumbar spinal surgery on improvement after treatment. There were no severe side effects. Short-lasting self limiting mild side effects were found in 26% (increased back pain, numbness, heartburn, headache, allergy).


CONCLUSIONS
Facet joint injection therapy using a standardized protocol is safe, effective, and easy to perform. The clinical effect is limited, and we recommend repetitive injection according to this protocol after 3 months.
Schulte
T L
TL
Department of Orthopaedics, University Hospital Münster, Münster, Germany. dr.tobias.schulte@web.de
Pietilä
T A
TA
Heidenreich
J
J
Brock
M
M
Stendel
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D017116:Low Back Pain / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019800:Phenol / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000187:drug effects* / Q000294:innervation / Q000473:pathology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D012597:Sclerosing Solutions; D019800:Phenol; D008012:Lidocaine; D011239:Prednisolone