Viscosupplementation in lumbar facet joint arthropathy: a pilot study.
BACKGROUND
Degeneration of the spine is a prevalent problem that generally advances with age, although its occurrence is not restricted to the elderly. Chronic low back pain is a common problem with several treatments, but rigorous evaluation of many interventions is still lacking. One of the most common methods of treating lumbar facet arthropathy is intra-articular injection of local anesthetic and steroid. However, in large joints, such as the knee, viscosupplementation has been shown to compare favorably to steroid in terms of symptom relief and duration of benefit. It is suggested that viscosupplementation may supersede steroid in treatment of symptomatic knee osteoarthritis. Hyaluronic acid (HA) therapy is still in its infancy in joints outside the knee, although some preliminary results are promising.


OBJECTIVE
This was a pilot study to test the potential effectiveness of HA injection therapy in the treatment of lumbar facet joint arthritis.


METHODS
Thirteen patients with symptomatic lumbar facet joint arthritis who met the inclusion criteria were prospectively recruited. Pretreatment evaluation of patients was by questionnaire, including the Visual Analog Score and Oswestry Disability Questionnaire. A single injection of HA into affected facet joints was then performed, with correct placement confirmed on fluoroscopy. The patients were similarly evaluated 6 weeks after treatment.


RESULTS
Eighteen facets in 13 patients were injected with HA. At 6-week follow up, there was no significant improvement in pain when measured on the Visual Analog Score. There was also no significant improvement in the Oswestry Disability Questionnaire.


CONCLUSIONS
Preliminary results from this pilot study do not demonstrate any benefit of viscosupplementation in the management of symptomatic lumbar facet arthropathy.
Cleary
May
M
Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. may.cleary@ireland.com
Keating
Ciara
C
Poynton
Ashley R
AR
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular / Q000706:statistics & numerical data; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D010865:Pilot Projects; D011446:Prospective Studies; D011859:Radiography; D013582:Synovial Fluid / Q000187:drug effects / Q000378:metabolism; D013583:Synovial Membrane / Q000187:drug effects / Q000378:metabolism; D017211:Treatment Failure; D021801:Zygapophyseal Joint / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid