J Korean Soc Radiol.  2015 Sep;73(3):172-180. 10.3348/jksr.2015.73.3.172.

Fluoroscopy-Guided Intra-Articular Facet Joint Steroid Injection for the Management of Low Back Pain: Therapeutic Effectiveness and Arthrographic Pattern

• Kim S
• Lee JW
• Chai JW
• Lee GY
• You JY
• Kang HS
• Ahn JM

• KMID: 2043608
• DOI: http://doi.org/10.3348/jksr.2015.73.3.172

Abstract

PURPOSE
To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage.
MATERIALS AND METHODS
In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists.
RESULTS
Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms.
CONCLUSION
Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

MeSH Terms

Follow-Up Studies
Humans
Incidence
Low Back Pain*
Medical Records
Recurrence
Retrospective Studies
Zygapophyseal Joint*

Figure

• 

  Fig. 1 A 35-year-old woman undergoing an intra-articular facet joint steroid injection at the left side L3/4 level. The fluoroscopic image shows an intra-articular sigmoid linear filling pattern (arrows).

• 

  Fig. 2 A 75-year-old man underwent intra-articular facet joint steroid injection from both sides at the L4/5 level. A. A fluoroscopic image of the left side L4/5 facet joint injection shows the intra-articular arthrographic pattern. B, C. On oblique (B) and anteroposterior (C) fluoroscopic images of the ipsilateral side L4/5 facet joint injection, there is contrast leakage into the epidural space (arrows).

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