Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study
The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilater...
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| description | The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73)) with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success) admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale) was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-), placebo-(sodium chloride-) and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain generator. |
| doi_str_mv | 10.1371/journal.pone.0027991 |
| format | Article |
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Mark</contributor><creatorcontrib>Schütz, Uwe ; Cakir, Balkan ; Dreinhöfer, Karsten ; Richter, Marcus ; Koepp, Holger ; Doherty, T. Mark</creatorcontrib><description>The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73)) with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success) admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale) was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-), placebo-(sodium chloride-) and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain generator.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0027991</identifier><identifier>PMID: 22140497</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anesthetics ; Anesthetics, Local - administration & dosage ; Back pain ; Bone surgery ; Chlorine compounds ; Clinical trials ; Cross-Over Studies ; Diagnosis ; Diagnostic systems ; Diagnostic tests ; Diskectomy, Percutaneous ; Female ; Fluoroscopy ; Humans ; Injection ; Injections, Intra-Articular ; Joint Diseases - diagnosis ; Joint Diseases - diagnostic imaging ; Local anesthesia ; Local anesthetics ; Low back pain ; Lumbar Vertebrae - diagnostic imaging ; Male ; Medical diagnosis ; Medical imaging ; Medical research ; Medicine ; Pain ; Pain - pathology ; Pain management ; Prospective Studies ; Radio frequency ; Radiology ; Sodium ; Sodium chloride ; Spine ; Spine (lumbar) ; Statistical analysis ; Surgery ; Surgical instruments ; Therapeutic Equivalency ; Zygapophyseal Joint - pathology</subject><ispartof>PloS one, 2011-11, Vol.6 (11), p.e27991</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Schütz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Schütz et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-34009db8ae72c796edd00e3c728bc4b54a5c926375a5d1df761c38d4946043603</citedby><cites>FETCH-LOGICAL-c691t-34009db8ae72c796edd00e3c728bc4b54a5c926375a5d1df761c38d4946043603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226632/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226632/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22140497$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Doherty, T. Mark</contributor><creatorcontrib>Schütz, Uwe</creatorcontrib><creatorcontrib>Cakir, Balkan</creatorcontrib><creatorcontrib>Dreinhöfer, Karsten</creatorcontrib><creatorcontrib>Richter, Marcus</creatorcontrib><creatorcontrib>Koepp, Holger</creatorcontrib><title>Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. 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Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain generator.</description><subject>Anesthetics</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Back pain</subject><subject>Bone surgery</subject><subject>Chlorine compounds</subject><subject>Clinical trials</subject><subject>Cross-Over Studies</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Diagnostic tests</subject><subject>Diskectomy, Percutaneous</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Humans</subject><subject>Injection</subject><subject>Injections, Intra-Articular</subject><subject>Joint Diseases - diagnosis</subject><subject>Joint Diseases - diagnostic imaging</subject><subject>Local anesthesia</subject><subject>Local anesthetics</subject><subject>Low back pain</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Pain</subject><subject>Pain - 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Mark</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2011-11-29</date><risdate>2011</risdate><volume>6</volume><issue>11</issue><spage>e27991</spage><pages>e27991-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73)) with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success) admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale) was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-), placebo-(sodium chloride-) and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain generator.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22140497</pmid><doi>10.1371/journal.pone.0027991</doi><tpages>e27991</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry; EZB Electronic Journals Library |
| subjects | Anesthetics Anesthetics, Local - administration & dosage Back pain Bone surgery Chlorine compounds Clinical trials Cross-Over Studies Diagnosis Diagnostic systems Diagnostic tests Diskectomy, Percutaneous Female Fluoroscopy Humans Injection Injections, Intra-Articular Joint Diseases - diagnosis Joint Diseases - diagnostic imaging Local anesthesia Local anesthetics Low back pain Lumbar Vertebrae - diagnostic imaging Male Medical diagnosis Medical imaging Medical research Medicine Pain Pain - pathology Pain management Prospective Studies Radio frequency Radiology Sodium Sodium chloride Spine Spine (lumbar) Statistical analysis Surgery Surgical instruments Therapeutic Equivalency Zygapophyseal Joint - pathology |
| title | Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study |
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