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Expired CME Article

Pain Relief With Intraarticular or Medial Branch Nerve Blocks in Patients With Positive Lumbar Facet Joint SPECT Imaging: A 12-Week Outcome Study

William E. Ackerman, III MD, Mahmood Ahmad, MD
Volume: 101 Issue: 9 September, 2008

Abstract:

Background: Single-photon emission computed tomography (SPECT) is useful in identifying patients who may respond to lumbar facet injections. There are two methods for performing lumbar facet joint injections: intraarticular and medial branch nerve blocks. A consensus has yet to be reached among physicians as to which method is the most effective. The purpose of this study was to compare the effectiveness of intraarticular and medial branch nerve blocks in SPECT-positive lumbar facet joint patients with nonradicular lower back pain.


Method: This study was a prospective, double-blinded outcome study of 12 weeks’ duration. Forty-six male (26) and female patients (20) between the ages of 18 and 55 (mean 39.3 years) with nonradicular lower back pain who were lumbar facet joint SPECT-positive were studied. No patient was included in this study if magnetic resonance imaging evidence of a lumbar disc herniation was present. Patients were randomly assigned by computer to have intraarticular (group I) or medial branch nerve blocks (group II) with lidocaine and triamcinolone, with 23 patients in each group. Outcome measurements assessed the Numeric Pain Intensity Scores (NPIS 0–10) and the Oswestry Disability Index scores (ODI 0–50).


Results: There were no differences in demographics between the two groups. The percentage of pain relief (61%) and the percentage of disability (53%) reduction were significantly greater (P <0.05) in group I when compared to group II (26% and 31% respectively).


Conclusions: Intraarticular lumbar facet joint injections are more effective than medial branch nerve blocks in SPECT-positive patients.


Key Points


* SPECT imaging may identify facet joint inflammation.


* Intraarticular facet joints are significantly effective in SPECT-positive patients.


* Median branch nerve blocks are not significantly effective in SPECT-positive patients.

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