Lumbar zygapophyseal joint injections in patients with chronic lower back pain

[Guest guest]

J Chin Med Assoc. 2005 Feb;68(2):59-64.

Lumbar zygapophyseal joint injections in patients with chronic lower

back pain.

Shih C, Lin GY, Yueh KC, Lin JJ.

Department of Radiology, Chu-Shang Show-Chwan Hospital, Nantou,

Taiwan, R.O.C.

BACKGROUND: This study was designed to assess the diagnostic value

and clinical benefits of lumbar zygapophyseal joint injections in

patients with chronic lower back pain.

METHODS: Two hundred and seventy-seven patients (136 males and 141

females, aged 15-82 years) with chronic lower back pain were enrolled

in the trial and met the following criteria: pain for more than 1

year; no root signs; and no history of back surgery. Under

fluoroscope, a 0.8-1.5 mL mixture of lidocaine, betamethasone

dipropionate and iopamidol (1:1:0.5) was injected into each joint

after intra-articular localization of the needle tip was confirmed. A

questionnaire with a pain scale was administered immediately or the

day after injection, and then after 1, 3, 6 and 12 weeks. Partial

arthrograms were reviewed by a radiologist.

RESULTS: Four hundred and forty-nine joint injections were performed

in 277 patients (L3-4, n = 76; L4-5, n = 272; L5-S1, n = 101).

Bilateral injections were performed in 117 patients (42.2%). The

study group comprised 204 patients (73.6%) with an excellent or good

response, whereas the control group comprised the remaining 73

patients (26.4%). The rates of good response in the study group were

72.1% (147/204) after 3 weeks, 40.7% (83/204) after 6 weeks, and

31.4% (64/204) after 12 weeks. Partial arthrograms revealed 25

patients (9.0%) with synovial cysts (L3-4, n = 3; L4-5, n = 14; L5-

S1, n = 8); 23 of these patients (92.0%) had a good response to the

injections. Five of the 6 patients with spondylolysis (83.3%), having

abnormal communication between the injected and contiguous joint, had

a good response to the injections. The abovementioned, abnormal

partial-arthrogram findings correlated significantly with the rate of

good response to the injections. Although 3 patients had contrast

medium extravasated into the epidural space during injection, none of

the 277 patients had deteriorating lower back pain after the

injections.

CONCLUSION: Lumbar zygapophyseal joint injections, as a useful

diagnostic tool for facet joint syndrome, could also have useful

palliative effects in the management of chronic lower back pain.