title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion.
abstract: The medical literature continues to fail to support the use of lumbar epidural injections for long-term relief of chronic back pain without radiculopathy. There is limited support for the use of lumbar epidural injections for shortterm relief in selected patients with chronic back pain. Lumbar intraarticular facet injections are not recommended for the treatment of chronic lower-back pain. The literature does suggest the use of lumbar medial nerve blocks for short-term relief of facet-mediated chronic lower-back pain without radiculopathy. Lumbar medial nerve ablation is suggested for 3-6 months of relief for chronic lower-back pain without radiculopathy. Diagnostic medial nerve blocks by the double-injection technique with an 80% improvement threshold are an option to predict a favorable response to medial nerve ablation for facet-mediated chronic lower-back pain without radiculopathy, but there is no evidence to support the use of diagnostic medial nerve blocks to predict the outcomes in these same patients with lumbar fusion. There is insufficient evidence to support or refute the use of trigger point injections for chronic lowerback pain without radiculopathy.
authors: Bone and Joint Clinic of Houston, Houston, Texas;
authors: William C
authors: WC
authors: Watters
authors: Daniel K
authors: DK
authors: Resnick
authors: Jason C
authors: JC
authors: Eck
authors: Zoher
authors: Z
authors: Ghogawala
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Andrew T
authors: AT
authors: Dailey
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Alok
authors: A
authors: Sharan
authors: Michael W
authors: MW
authors: Groff
authors: Jeffrey C
authors: JC
authors: Wang
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007268:Injections, Epidural / Q000592:standards*; D017116:Low Back Pain / Q000473:pathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000473:pathology / Q000601:surgery*; D009407:Nerve Block / Q000592:standards*; D017410:Practice Guidelines as Topic; D013122:Spinal Diseases / Q000473:pathology / Q000628:therapy*; D013123:Spinal Fusion / Q000592:standards*
keywords: ESI = epidural steroid injection; NRS = Numerical Rating Scale; ODI = Oswestry Disability Index; RCT = randomized control trial; TPI = trigger point injection; VAS = visual analog scale; epidural steroid injection; facet block; fusion; low-back pain; lumbar spine; practice guidelines; trigger point injection