The comparison of pain relief between fluoroscopic guided and free hand lumbar facet infiltration for lumbar facet syndrome

Abstract

Background: Lumbar facet syndrome has become a commonly accepted term for lower back pain caused primarily by the facet joints of the lumbar spine. Listed as one of the most common causes for patients to seek medical counsel, lumbar facet syndrome is a frequent diagnostic and treatment conundrum for medical practitioners. Lumbar facet infiltration techniques have been used for over half a century in an attempt to alleviate symptoms of the disease process. This study has attempted to discern whether the standard lumbar facet infiltration with the use of fluoroscopy is superior in terms of pain relief to a technique using no fluoroscopy, but rather a free handed technique guided on sound anatomical landmarks. Method: A total of 40 patients, eligible for the study according to the inclusion criteria, were recruited for the study. All patients participated and were randomised into 2 groups of 20 patients each. Group 1 patients received a lumbar facet infiltration procedure with fluoroscopic guidance, Group 2 patients received a lumbar facet infiltration procedure with the free hand technique. Randomisation separated male and female (10:10 group 1 and 11:9 group 2). All 40 patients were included to the results with age ranging 24-73 years of age. Patients would score their pain experienced due to lumbar facet syndrome on the Visual analogue Scale (VAS)(0-10) as well as completing the Oswestry Low Back Pain Disability Questionnaire which would score their disability secondary to lower back pain as a percentage namely the Oswestry Low Back Pain Disability Score (OLBPDS). Data was collected over a period of 12 months with patients providing information pre-lumbar facet infiltration, 1 hour post infiltration, 24 hours post infiltration, 1 week post infiltration and 4 weeks post infiltration. Results: Results showed a suggestion of improvement in disability secondary to pain and in lower back pain in both techniques, particularly after 1 week (Group 1- OLBPDS 57%-49.5%, VAS 8-6) (Group 2 – OLBPDS 58%-43%, VAS 8-7), however, all p-values are above 0.05 and thus there is no statistical significance, this was reproduced at 1 hour, 24 hours, 1 week and 4 weeks procedure. Conclusion: symptomatic treatment of lumbar facet syndrome by facet infiltration is effective in temporary pain relief. Both fluoroscopic guided and free hand techniques show improvement in lower back pain and disability secondary to pain without a statistically significant difference in the amount of pain relief experienced or a difference in the change in the disability index between the 2 procedures. One can thus suspect that the free handed anatomic technique of lumbar facet infiltration may provide a faster, cheaper procedure to treat symptomatic lumbar facet syndrome in comparison with the standard fluoroscopic technique as results in pain relief and improvement in disability are comparable. Future studies with larger study populations will be needed to confirm this study.