J Korean Soc Spine Surg.  2012 Dec;19(4):164-170. 10.4184/jkss.2012.19.4.164.

Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

Affiliations
  • 1Department of Orthopedic Surgery, School of Medicine, Seoul National University Hospital, Seoul, Korea.
  • 2Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea. osshim@wku.ac.kr
  • 3Institute of Wonkwang Medical Science, Iksan, Korea.

Abstract

STUDY DESIGN: Level III, retrospective studies.
OBJECTIVES
This study is conducted to evaluate the effect and usefulness of ultrasound guided facet block for the outpatients who complained of chronic lower back pain. SUMMARY OF THE LITERATURE REVIEW: Facet joint syndrome was introduced in 1976, by Mooney V. It was considered to be one of the major causes of low back pain.
MATERIALS AND METHODS
Between October 2009 to March 2011, 98 cases were selected from the outpatients who complained of chronic lower back pain for more than 3 months. The patients had no surgery history and did not complain of neuromuscular symptoms, and they had more than three times outpatient care at least and could be followed up for 1 year. The patients were divided into three groups; first was the ultrasound guided facet block group (27 cases), second was the Fluoroscopy guided facet block group (39cases) and third was the conservative group (32 cases).The clinical results were analyzed using Kim's criteria and the Visual Analog Scale score, ODI score, Physician's global assessment (subjective), Patient's global assessment (Objective).
RESULTS
The VAS score was improved from an average of 7.75+/-1.5 to 4.47+/-2.4 in the ultrasound guided facet block group, and from 7.81+/-1.4 to 4.39+/-2.6 in the Fluoroscopy guided facet block group, and from 7.87+/-1.3 to 6.24+/-2.1 in the conservative group. The VAS score, Kim's criteria, ODI score, Physician's global assessment (subjective), and Patient's global assessment (Objective) showed statistically significant improvement in the ultrasound guided facet block group and Fluoroscopy guided facet block group.
CONCLUSION
In the outpatient clinics, comparing with the group that underwent conservative treatment with medication, the group treated with ultrasound for block could have better results in clinical improvement.

Keyword

Ultrasound; Facet joint block; Chronic low back pain

MeSH Terms

Ambulatory Care
Ambulatory Care Facilities
Fluoroscopy
Humans
Low Back Pain
Outpatients
Retrospective Studies
Zygapophyseal Joint

Figure

  • Fig. 1. All the procedures were performed with the patient in the prone position. (A) location of the needle at superiolateral edge of the lateral facet. (B) Sonography show facet joint injection.


Reference

1.Mooney V., Robertson J. The facet syndrome. Clin Orthop Relat Res. 1976. 115:149–56.
Article
2.Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988. 318:291–300.
Article
3.Bogduk N. International Spinal Injection Society Guidelines for the Performance of Spinal Injection Procedures.: Part 1: Zygapophysial Joint Blocks. Clin J Pain. 1997. 13:285–302.
4.Gangi A., Dietemann JL., Mortazavi R., Pfleger D., Kauff C., Roy C. CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics. 1998. 18:621–33.
Article
5.Saal JS. General principles of diagnostic testing as re-lated to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine (Phila Pa 1976). 2002. 27:2538–45.
6.Greher M., Scharbert G., Kamolz LP, et al. Ultrasound-guided lumbar facet nerve block: a sonoanatomic study of a new methodologic approach. Anesthesiology. 2004. 100:1242–8.
7.Rauch S., Kasuya Y., Turan A., Neamtu A., Vinayakan A., Sessler DI. Ultrasound-guided lumbar medial branch block in obese patients: a fluoroscopically confirmed clinical feasibility study. Reg Anesth Pain Med. 2009. 34:340–2.
8.Shim JK., Moon JC., Yoon KB., Kim WO., Yoon DM. Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med. 2006. 31:451–4.
Article
9.Eisenstein SM., Parry CR. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. J Bone Joint Surg Br. 1987. 69:3–7.
Article
10.Ahn MW. Degenerative Instability of the Lumbar Spine. J Korean Soc Spine Surg. 2007. 14:292–304.
Article
11.Jeon CH., Lee WI., Kang SY. Intra and Extraspinal Infected Synovial Cyst of the Lumbar Spine-Case Report. J Korean Soc Spine Surg. 1997. 4:357–64.
12.Helbig T., Lee CK. The lumbar facet syndrome. Spine (Phila Pa 1976). 1988. 13:61–4.
Article
13.Pedersen HE., Blunck CF., Gardner E. The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves) with an experimental study of their functions. J Bone Joint Surg Am. 1956. 38:377–91.
14.Hirsch C., Ingelmark BE., Miller M. The anatomical basis for low back pain: Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine. Acta orthopaedica. 1963. 33:1–17.
Article
15.Kellgren J. Referred Pains from Muscle. Br Med J. 1938. 12:325–7.
Article
16.Mooney V. The syndromes of low back disease. Orthop Clin North Am. 1983. 14:505–15.
Article
17.Rees WS. Rhysolysis of the nerves of the zygoapophyseal joints. Spine (Phila Pa 1976). 1983. 8:118–20.
18.Shealy CN. Facet denervation in the management of back and sciatic pain. Clin Orthop Relat Res. 1976. 115:157–64.
Article
19.Silvers HR. Lumbar percutaneous facet rhizotomy. Spine (Phila Pa 1976). 1990. 15:36–40.
Article
20.Smith DL., Heldt JP., Richards GD., Agarwal G., Brisbane W., Chen CJ., Chamberlain J., Baldwin DD. Radiation Exposure During Continuous and Pulsed Fluoroscopy. J Endouro. 2012 Sep 11.
Article
21.Kirchmair L., Entner T., Kapral S., Mitterschiffthaler G. Ultrasound guidance for the psoas compartment block: an imaging study. Anesth Analg. 2002. 94:706–10.
Article
22.Kirchmair L., Entner T., Wissel J., Moriggl B., Kapral S., Mitterschiffthaler G. A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block. Anesth Analg. 2001. 93:477–81.
Article
23.Greher M., Kirchmair L., Enna B., Kovacs P., Gustorff B., Kapral S., Moriggl B. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology. 2004. 101:1195–200.
24.Galiano K., Obwegeser AA., Bodner G., Freund M., Maurer H., Kamelger FS., Schatzer R., Ploner F. Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study. Anesth Analg. 2005. 101:579–83.
Article
25.Shim DM., Kim TK., Oh SK., Lee SJ., Yang HS. Comparison of Ultrasonography and Magnetic Resonance Imaging in Measurement of Lumbar Spine Anatomic Structures. Journal of the Korean Orthopaedic Association. 2012. 47:140–5.
Article
26.Lippitt AB. The facet joint and its role in spine pain. Man-agement with facet joint injections. Spine. 1984. 9:746–50.
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