Ultrasound-guided facet block to low back pain: a case report

osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. female patient, 88 years old, 1.68m and 72kg, with facet osteoarthrosis at L2–L3, L3–L4 and L4–L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3–L4. A 25G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1mL of solution containing 0.25% bupivacaine hydrochloride and 10mg of methylprednisolone acetate was injected. Injections into L3–L4, L2–L3 and L1–L2 to the right were applied. the visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. A osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. Paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2–L3, L3–L4 e L4–L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3–L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1mL de contraste, confirmado com fluoroscopia. Após as