title: Facet joint injections as a means of reducing the need for vertebroplasty in insufficiency fractures of the spine.
abstract: OBJECTIVE
  Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself.
  
  
  METHODS
  Patients referred for treatment by vertebroplasty were first offered local anaesthetic and steroid facet joint injection (FJI) at the most painful level. Those who failed to respond were offered a vertebroplasty.
  
  
  RESULTS
  Ninety one patients referred, 16 went straight to vertebroplasty. Sixty one of 75 were initially offered FJI. Twenty one were successful; two relapsed, had further FJIs with good results; three declined treatment; 5 had temporary benefit; 1 died from unrelated causes. Of 29 who failed to respond to FJIs, 24 underwent vertebroplasty and 23 had a successful outcome.
  
  
  CONCLUSIONS
  A third of patients technically suitable for vertebroplasty responded beneficially to FJI. In this group the pain mediator maybe one of instability and overload on the facet joints produced by adjacent wedge fracture. This protocol allows more selective and more successful vertebroplasty.
authors.affiliation: Nuffield Orthopaedic Centre NHS Trust, Oxford, OX3 7LD, UK. djwilson@herald.ox.ac.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: Sara
authors.initials: S
authors.lastname: Owen
authors.forename: Rufus A
authors.initials: RA
authors.lastname: Corkill
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D008297:Male; D010147:Pain Measurement; D016103:Spinal Fractures / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty; D021801:Zygapophyseal Joint
chemical_list: D000779:Anesthetics, Local