Ultrasound versus fluoroscopy-guided medial branch block for the treatment of lower lumbar facet joint pain: A retrospective comparative study

Seung Hoon Han, Ki Deok Park, Kyoung Rai Cho, Yongbum Park, Seung Hoon Han, Ki Deok Park, Kyoung Rai Cho, Yongbum Park

Abstract

The aim of this study was to compare the mid-term effects and benefits of ultrasound (US)-guided and fluoroscopy (FL)-guided medial branch blocks (MBBs) for chronic lower lumbar facet joint pain through pain relief, functional improvement, and injection efficiency evaluation.Patients with chronic lumbar facet joint pain who received US (n = 68) or FL-guided MBBs (n = 78) were included in this retrospective study. All procedures were performed under FL or US guidance. Complication frequency, therapeutic effects, functional improvement, and the injection efficiency of MBBs were compared at 1, 3, and 6 months after the last injection.Both the Oswestry Disability Index (ODI) and the verbal numeric pain scale (VNS) improved at 1, 3, and 6 months after the last injections in both groups. Statistical differences were not observed in ODI and VNS between the groups (P > .05). The proportion of patients who reported successful treatment outcomes showed no significant differences between the groups at different time points. Logistic regression analysis showed that sex, pain duration, injection methods, number of injections, analgesic use, and age were not independent predictors of a successful outcome. US guidance was associated with a significantly shorter performance time.US-guided MBBs did not show significant differences in analgesic effect and functional improvement compared with the FL-guided approach. Therefore, by considering our data from this retrospective study, US-guided MBBs warrant consideration in the conservative management of lower lumbar facet joint pain.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound-guided medial branch block. (A) Long-axis view of the lumbar spine showing the L5 spinous process and median S1 crest (SC). (B) Long-axis view of the lumbar spine with L4/L5 and L5/S1 facet joint contours and the S1 (arrow) dorsal foramen. (C) Long-axis view showing the L4 and L5 transverse processes and the sacral ala (SA). Upper edge of the transverse process, or the sacral ala, immediately lateral to the superior articular process is the correct anatomical target (arrow). (D) Short-axis view of the sacrum showing the S1 median crest (arrow head) and the surface of the sacrum (arrow). (E) Short-axis view of L4/L5 segment showing the interspinous ligament (ISL), L5 superior articular process (SAP), and L4 transverse process (TP). Target point on between the L5 superior articular process (SAP) and the L4 transverse process for an approach toward the right-sided L4 medial branch (arrow). (F) Short-axis view of the lumbosacral segment showing the interspinous ligament (ISL), S1 superior articular process (SAP), the sacral ala (SA), and the iliac crest (IC). Target point is between the S1 superior articular process (SAP) and the sacral ala for an approach to the right-sided L5 dorsal ramus (arrow).
Figure 2
Figure 2
Ultrasound-guided medial branch block by a posterolateral approach with short-axis view and an in-plane free-hand technique. (A) The needle (arrow) is positioned using short axis in-plain approach to the angle between superior articular process (SAP) and the transverse process (TP) for a right-sided L4 medial branch block. (B) Check-up of the needle tip (N) positioned at the upper part of the L5 transverse process (L5) is facilitated using a long-axis and out-of-plane view.
Figure 3
Figure 3
Fluoroscopy-guided medial branch block. (A) Anteroposterior view. The contrast medium filled the L4/L5 superior articular processes for the L3/L4 medial branch block and the groove between the ala of the sacrum and the superior articular process of the sacrum for the L5 dorsal ramus. (B) Lateral view.
Figure 4
Figure 4
Subjects flow diagram.

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Source: PubMed

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