Clinical Outcome of Facet Joints Injection in Patients With Lumbar Facet Joints Arthropathy
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Abstract
Introduction: Facet joint injection (FJI) combined with steroids is known to be effective for lumbar facet joint arthropathy (FJA). This study evaluates its impact using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) to measure function and pain, respectively, before and six months after treatment. Additionally, the study examined the relationship between body mass index (BMI), vitamin D levels, and functional outcomes as indicated by ODI scores. Materials and methods: Thirty-six patients underwent lumbar FJI at the L3/L4, L4/L5, and L5/S1 levels. Changes in ODI and VAS scores were analysed using paired T-tests. To examine the mean differences in ODI scores before and six months after treatment, a One-way ANOVA was conducted, with post-hoc analysis using the Dunnett T3 test for significant results. A p-value < 0.05 was considered statistically significant. Results: Significant improvements in functionality and pain were observed, as indicated by ODI and VAS scores. Notably, patients with a normal BMI showed marked functional improvement. The One-way ANOVA revealed a positive correlation between vitamin D levels and ODI scores, with the post-hoc analysis indicating that patients with optimal vitamin D status had the best outcomes. Conclusion: Patients with lumbar FJA who have a normal BMI and optimal vitamin D levels demonstrated significantly improved clinical outcomes at six months.
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Manchikanti L, Knezevic E, Knezevic NN, Sanapati MR, Kaye AD, Abdi S, et al. Effectiveness of facet joint nerve blocks in managing chronic axial spinal pain of facet joint origin: a systematic review and meta-analysis. Pain Physician. 2024;27(2):E169-206. Available from: https://pubmed.ncbi.nlm.nih.gov/38324785/. PMID: 38324785.
Ambrosio L, Vadalà G, Russo F, Pascarella G, De Salvatore S, Papalia GF, et al. Interventional minimally invasive treatments for chronic low back pain caused by lumbar facet joint syndrome: a systematic review. Global Spine J. 2023;13(4):1163-79. doi: 10.1177/21925682221142264.
Liu M, Shaparin N, Nair S, Kim RS, Hascalovici JR. Chronic low back pain: the therapeutic benefits of diagnostic medial branch nerve blocks. Pain Physician. 2021;24(4):E521-8. Available from: https://pubmed.ncbi.nlm.nih.gov/34213878/. PMID: 34213878.
Manchikanti L, Kaye AD, Soin A, Albers SL, Beall D, Latchaw R, et al. Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain Physician. 2020;23(3S):S1-127. Available from: https://pubmed.ncbi.nlm.nih.gov/32503359/. PMID 32503359.
Won HS, Yang M, Kim YD. Facet joint injections for management of low back pain: a clinically focused review. Anesth Pain Med (Seoul). 2020;15(1):8-18. doi: 10.17085/apm.2020.15.1.8.
Yoo YM, Kim KH. Facet joint disorders: from diagnosis to treatment. Korean J Pain. 2024;37(1):3-12. doi: 10.3344/kjp.23228.
Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Biryuchkov MY, Jubaeva BA, et al. The relationship of radiographic parameters and morphological changes at various stages of degeneration of the lumbar facet joints: cadaver study. Global Spine J. 2024;14(1):195-203. doi: 10.1177/21925682221099471.
Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiol. 2023;52(10):1873-86. doi: 10.1007/s00256-022-04184-5.
Wong MJ, Rajarathinam M. Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review. Can J Pain. 2023;7(2):2193617. doi: 10.1080/24740527.2023.2193617.
Acosta Julbe JI, Mandell JC, Ermann J, Isaac Z, Gottreich JR, Zampini JM, et al. Predictors of outcomes after lumbar intra-articular facet joint injections and medial branch blocks: a scoping review. Spine (Phila Pa 1976). 2023;48(20):1455-63. doi: 10.1097/BRS.0000000000004776.
Nisolle ML, Ghoundiwal D, Engelman E, El Founas W, Gouwy J, Guntz E, et al. Comparison of the effectiveness of ultrasound-guided versus fluoroscopy-guided medial lumbar bundle branch block on pain related to lumbar facet joints: a multicenter randomized controlled non-inferiority study. BMC Anesthesiol. 2023;23(1):76. doi: 10.1186/s12871-023-02029-9.
Du R, Xu G, Bai X, Li Z. Facet joint syndrome: pathophysiology, diagnosis, and treatment. J Pain Res. 2022;15:3689-710. doi: 10.2147/JPR.S389602.
Ghormly RK. Low back pain: with special reference to the articular facets, with presentation of an operative procedure. JAMA. 1933;101(23):1773-7. doi:10.1001/jama.1933.02740480005002.
Nisolle ML, Bourguignon A. Management of chronic low back pain: news on the lumbar medial branch block and the importance of the biopsychosocial model. Anaesthesiol Intensive Ther. 2023;55(5):382-3. doi: 10.5114/ait.2023.134272.
Kim BY, Concannon TA, Barboza LC, Khan TW. The role of diagnostic injections in spinal disorders: a narrative review. Diagnostics (Basel). 2021;11(12):2311. doi: 10.3390/diagnostics11122311.
Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424–67. doi: 10.1136/rapm-2019-101243.
Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine (Phila Pa 1976). 1998;23(18):1972-77. doi:10.1097/00007632-199809150-00011.
Almeer G, Azzopardi C, Kho J, Gupta H, James SL, Botchu R. Anatomy and pathology of facet joint. J Orthop. 2020;22:109-17. doi: 10.1016/j.jor.2020.03.058.
Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018;9(5):773-89. doi: 10.1007/s13244-018-0638-x.
Shin DA, Choo YJ, Chang MC. Spinal injections: a narrative review from a surgeon's perspective. Healthcare (Basel). 2023;11(16):2355. doi: 10.3390/healthcare11162355.
Little JW, Grieve T, Cantu J, Bogar WC, Heiser R, Miley H, et al. Reliability of human lumbar facet joint degeneration severity assessed by magnetic resonance imaging. J Manipulative Physiol Ther. 2020;43(1):43-9. doi: 10.1016/j.jmpt.2018.11.027.
Lilius G, Harilainen A, Laasonen EM, Myllynen P. Chronic unilateral low-back pain. Predictors of outcome of facet joint injections. Spine (Phila Pa 1976). 1990;15(8):780-2. Available from: https://pubmed.ncbi.nlm.nih.gov/2146756/. PMID: 2146756.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54. doi: 10.1093/aje/kwp356.
e Silva AV, Lacativa PG, Russo LA, de Gregório LH, Pinheiro RA, Marinheiro LP. Association of back pain with hypovitaminosis D in postmenopausal women with low bone mass. BMC Musculoskelet Disord. 2013;14:184. doi: 10.1186/1471-2474-14-184.
Lodh M, Goswami B, Mahajan RD, Sen D, Jajodia N, Roy A. Assessment of Vitamin D status in patients of chronic low back pain of unknown etiology. Indian J Clin Biochem. 2015;30(2):174-9. doi: 10.1007/s12291-014-0435-3.
Lee CP, Fu TS, Liu CY, Hung CI. Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses. Health Qual Life Outcomes. 2017;15(1):192. doi: 10.1186/s12955-017-0768-8.
Annaswamy TM, Armstead C, Carlson L, Elkins NJ, Kocak D, Bierner SM. Intra-articular triamcinolone versus hyaluronate injections for low back pain with symptoms suggestive of lumbar zygapophyseal joint arthropathy: a pragmatic, double-blind randomized controlled trial. Am J Phys Med Rehabil. 2018;97(4):278-84. doi: 10.1097/PHM.0000000000000879.
Chuan Yen T, Mohler J, Dohm M, Laksari K, Najafi B, Toosizadeh N. The effect of pain relief on daily physical activity: in-home objective physical activity assessment in chronic low back pain patients after paravertebral spinal block. Sensors (Basel). 2018;18(9):3048. doi: 10.3390/s18093048.
Motawea AM, El Kholy MR, Ebied OM, Mousa WAEF, Abdullah MS. Imaging-guided facet joint injection technique for lower back pain management. Am J Health Res. 2015;3(2):52-6. doi: 10.11648/j.ajhr.20150302.11.
Peh WCG. Image-guided facet joint injection. Biomed Imaging Interv J. 2011;7(1):e4. doi: 10.2349/biij.7.1.e4.
Tan HK, Chew KM, Peh WCG. Percutaneous imaging-guided spinal facet joint injections. Tech Orthop. 2013;28(1):12-17. doi: 10.1097/BTO.0b013e3182897364.
Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007;10(3):425-40. Available from: https://pubmed.ncbi.nlm.nih.gov/17525777/. PMID: 17525777.
Manchikanti L, Pampati V, Bakhit CE, Rivera JJ, Beyer CD, Damron KS, et al. Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial. Pain Physician. 2001;4(1):101-17. Available from: https://pubmed.ncbi.nlm.nih.gov/16906173/. PMID: 61906173.
Dzefi-Tettey K, Edzie EKM, Mensah SK, Osei S, Piersson AD, Amedi MK, et al. Lumbar facet joint arthrosis on magnetic resonance imaging and its association with low back pain in a selected Ghanaian population. J Neurosci Rural Pract. 2023;14(4):681-5. doi: 10.25259/JNRP_94_2023.
Sheng B, Feng C, Zhang D, Spitler H, Shi L. Associations between obesity and spinal diseases: a medical expenditure panel study analysis. Int J Environ Res Public Health. 2017;14(2):183. doi: 10.3390/ijerph14020183.
Christodoulou S, Goula T, Ververidis A, Drosos G. Vitamin D and bone disease. Bio Med Res Int. 2013;2013:396541. doi: 10.1155/2013/396541.
Gokcek E, Kaydu A. Assessment of relationship between vitamin D deficiency and pain severity in patients with low back pain: a retrospective, observational study. Anesth Essays Res. 2018;12(3):680-4. doi: 10.4103/aer.AER_96_18.
Ross JJ, Ard KL. Septic arthritis of the spinal facet joint: review of 117 cases. Open Forum Infect Dis. 2024;11(3):ofae091. doi: 10.1093/ofid/ofae091.