Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

Ivan Dias da Rocha, Alexandre Fogaça Cristante, Raphael Martus Marcon, Reginaldo Perilo Oliveira, Olavo Biraghi Letaif, Tarcisio Eloy Pessoa de Barros Filho, Ivan Dias da Rocha, Alexandre Fogaça Cristante, Raphael Martus Marcon, Reginaldo Perilo Oliveira, Olavo Biraghi Letaif, Tarcisio Eloy Pessoa de Barros Filho

Abstract

Objectives: To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables.

Methods: Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients.

Results: A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05).

Conclusion: Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.

Trial registration: ClinicalTrials.gov NCT01367860.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
A radiograph in the anterior-posterior view during the controlled medial branch block procedure in one patient, with needles positioned in the medial branches of L3, L4 and L5 (left).
Figure 2
Figure 2
Flowchart detailing the inclusion and exclusion criteria of patients in the diagnostic study.
Figure 3
Figure 3
Patient distribution at each evaluation time, according to their VAS scores (n = 54).

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