title: Accuracy and efficacy of fluoroscopy-guided pars interarticularis injections on immediate and short-term pain relief.
abstract: OBJECTIVE
  To determine the accuracy and short-term efficacy of fluoroscopy-guided steroid/anesthetic injections for symptomatic pars interarticularis (pars) defects.
  
  
  METHODS
  Following IRB approval, all fluoroscopically guided pars injections from a single institution (6/2010 to 3/2016) were retrospectively and independently reviewed by two MSK radiologists. The radiologists evaluated the fluoroscopic images to determine if all of the pars injections associated with each procedure were intra-pars (n = 57 procedures; 106 pars injections), peri-pars (n = 3 procedures; three pars injected), or a combination of intra-pars and peri-pars (n = 6 procedures; 12 pars injected). The patients were asked their pain score (graded on a scale of 0-10) pre-injection, 5-10 min and 1-week post-injection. Age, gender, and fluoroscopic times were recorded. Statistical analysis was performed on the all intra-pars injections only.
  
  
  RESULTS
  Exact inter-reader agreement was present in 92 % (112/121) of the injections, with 57 of the procedures (106 pars injections) performed on 41 patients (mean age 36; 18 M, 23 F) all intra-pars. The mean pre-injection and 5-10 min post-injection reduction in pain for the all intra-pars injections was -3.0 units (95 % CI: [-3.9, -2.1] units; p < 0.001) with a mean 1-week post-injection (n = 21 procedures; 38 pars) reduction in pain of -0.7 units (95 % CI [-1.5, 0.0]; p = 0.06). The geometric mean fluoroscopic time per pars injected was 42 s.
  
  
  CONCLUSIONS
  Over 92 % of fluoroscopically guided injections for symptomatic spondylolysis are technically successful with minimum fluoroscopic time, resulting in statistically significant pain reduction immediately post-injection and a trend in pain reduction 1-week post-injection.
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA.|Colorado Imaging Associates, 1819 Denver W Dr #101, Golden, CO, 80401, USA.
authors.forename: L Michael
authors.initials: LM
authors.lastname: Kershen
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Nacey
authors.affiliation: Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA. mf3kx@virginia.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D017116:Low Back Pain / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D010147:Pain Measurement / Q000187:drug effects*; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013169:Spondylolysis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D013256:Steroids
keywords: Anesthetics; Fluoroscopy; Injections; Pain; Spondylolysis