Outcome of intra‑articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis

Kwak,Dong  Gyu; Kwak,Sang  Gyu; Lee,Ah  Young; Chang,Min  Cheol

doi:10.3892/etm.2019.8031

Outcome of intra‑articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis

Authors:
- Dong Gyu Kwak
- Sang Gyu Kwak
- Ah Young Lee
- Min Cheol Chang
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Affiliations: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea, Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu 42472, Republic of Korea, Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Daegu 38453, Republic of Korea
Published online on: September 20, 2019 https://doi.org/10.3892/etm.2019.8031
Pages: 4132-4136

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Abstract

Lumbar facet joint osteoarthritis (FJOA) caused by degenerative change(s) is considered to be the main cause of facet joint‑origin low back pain (LBP). Intra‑articular lumbar facet joint (IA LFJ) corticosteroid injection is widely used for controlling pain induced by FJOA. In the current study, the outcomes of IA LFJ corticosteroid injection were evaluated according to the severity of FJOA. A total of 50 patients who received IA LFJ corticosteroid injections for the treatment of LFJ pain were recruited. Patients were classified into three groups according to the severity of FJOA, which was indicated during a lumbar axial MRI. A total of 10 patients were assigned to group A (patients with mild FJOA), 27 to group B (patients with moderate FJOA) and 13 to group C (patients with severe FJOA). Pain intensity was evaluated using a numerical rating scale (NRS) prior to treatment and at 1, 2 and 3 months after treatment. A total of 26 (52%) patients experienced successful treatment outcomes (defined as >50% reduction in NRS score at 3 months). Patients in all groups demonstrated a significant decrease in NRS scores at 1, 2 and 3 months after IA LFJ corticosteroid injection compared with the pre‑treatment score (P<0.001). However, the effect of IA LFJ corticosteroid injection was not significantly different among the three groups (P=0.889). The results demonstrated that facet joint‑origin LBP was significantly reduced after IA LFJ corticosteroid injection, regardless of the severity of FJOA. The results of the current study indicated that IA LFJ corticosteroid injection is a beneficial clinical option for managing LBP caused by FJOA.

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1	Vekaria R, Bhatt R, Ellard DR, Henschke N, Underwood M and Sandhu H: Intra-articular facet joint injections for low back pain: A systemic review. Eur Spine J. 25:1266–1281. 2016. View Article : Google Scholar : PubMed/NCBI
2	Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, Heck O, Boubagra K, Grand S and Krainik A: Facet joint syndrome: From diagnosis to interventional management. Insights Imaging. 9:773–789. 2018. View Article : Google Scholar : PubMed/NCBI
3	Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G and Bogduk N: Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976). 19:1132–1137. 1994. View Article : Google Scholar : PubMed/NCBI
4	Bogduk N: The anatomical basis for spinal pain syndromes. J Manipulative Physiol Ther. 18:603–605. 1995.PubMed/NCBI
5	Ashton IK, Ashton BA, Gibson SJ, Polak JM, Jaffray DC and Eisenstein SM: Morphological basis for back pain: The demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res. 10:72–78. 1992. View Article : Google Scholar : PubMed/NCBI
6	Kuslich SD, Ulstrom CL and Michael CJ: The tissue origin of low back pain and sciatica: A report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 22:181–187. 1991.PubMed/NCBI
7	Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS and Beyer CD: Prevalence of facet joint from in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 5:152004. View Article : Google Scholar : PubMed/NCBI
8	Marks R: Distribution of pain provoked from lumbar facet joints and related structures during diagnostic spinal infiltration. Pain. 39:37–40. 1989. View Article : Google Scholar : PubMed/NCBI
9	Eubanks JD, Lee MJ, Cassinelli E and Ahn NU: Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: An anatomic study of cadaveric specimens. Spine (Phila Pa 1976). 32:2058–2062. 2007. View Article : Google Scholar : PubMed/NCBI
10	Gellhorn AC, Katz JN and Suri P: Osteoarthritis of the spine: The facet joints. Nat Rev Rheumatol. 9:216–224. 2013. View Article : Google Scholar : PubMed/NCBI
11	Lawrence RC: Estimates of the prevalence of arthritis and selected musculoskeletal disordersin the United States. Arthritis Rheum. 16:427–441. 1989.
12	Kang YM, Choi WS and Pickar JG: Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues. Spine (Phila Pa 1976). 27:E56–E63. 2002. View Article : Google Scholar : PubMed/NCBI
13	Cavanaugh JM, Ozaktay AC, Yamashita T, Avramov A, Getchell TV and King AI: Mechanisms of low back pain: A neurophysiologic and neuroanatomic study. Clin Orthop Relat Res. 166–180. 1997. View Article : Google Scholar : PubMed/NCBI
14	Cohen SP, Huang JH and Brummett C: Facet joint pain-advances in patient selection and treatment. Nat Rev Rheumatol. 9:101–116. 2013. View Article : Google Scholar : PubMed/NCBI
15	Bellamy N, Campbell J, Robinson V, Gee T, Bourne R and Wells G: Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 19:CD0053282006.
16	Buchbinder R, Green S and Youd JM: Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. CD0040162003.PubMed/NCBI
17	Machado E, Bonotto D and Cunali PA: Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: A systemic review. Dental Press J Orthod. 18:128–133. 2013. View Article : Google Scholar : PubMed/NCBI
18	Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y and Latulippe M: A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. 325:1002–1007. 1991. View Article : Google Scholar : PubMed/NCBI
19	Schulte TL, Pietilä TA, Heidenreich J, Brock M and Stendel R: Injection therapy of lumbar facet syndrome: A prospective study. Acta Neurochir (Wien). 148:1165–1172. 2006. View Article : Google Scholar : PubMed/NCBI
20	Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V and McManus CD: Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: A preliminary report of a randomized, double-blind controlled trial: Clinical trial NCT00355914. Pain Physician. 10:425–440. 2007.PubMed/NCBI
21	Farrar JT, Young JP Jr, LaMoreaux L, Werth JL and Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 94:149–158. 2001. View Article : Google Scholar : PubMed/NCBI
22	Maataoui A, Voql TJ, Middendorp M, Kafchitsas K and Khan MF: Association between facet joint osteoarthritis and the Oswestry Disability Index. World J Radiol. 6:881–885. 2014. View Article : Google Scholar : PubMed/NCBI
23	Groen GJ, Baljet B and Drukker J: Nerves and nerve plexuses of the human vertebral column. Am J Anat. 188:282–296. 1990. View Article : Google Scholar : PubMed/NCBI
24	Chen C, Lu Y, Kallakuri S, Patwardhan A and Cavanaugh JM: Distribution of A-delta and C-fiber receptors in the cervical facet joint capsule and their response to stretch. J Bone Joint Surg Am. 88:1807–1816. 2006. View Article : Google Scholar : PubMed/NCBI
25	Lee DG, Ahn SH and Lee J: Comparative effectiveness of pulsed radiofrequency and transforaminal steroid injection for radicular pain due to disc herniation: A prospective randomized trial. J Korean Med Sci. 31:1324–1330. 2016. View Article : Google Scholar : PubMed/NCBI
26	Olmarker K, Byröd G, Cornefjord M, Nordborg C and Rydevik B: Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine (Phila Pa 1976). 19:1803–1808. 1994. View Article : Google Scholar : PubMed/NCBI
27	Lee DG, Cho YW, Cho KH and Chang MC: Management of refractory sciatic neuropathic pain using ultrasound-guided pulsed radiofrequency. J Back Musculoskelet Rehabil. 30:1141–1145. 2017. View Article : Google Scholar : PubMed/NCBI
28	Barnes PJ: Anti-inflammatory actions of glucocorticoids: Molecular mechanisms. Clin Sci (Lond). 94:557–572. 1998. View Article : Google Scholar : PubMed/NCBI
29	Suri P, Hunter DJ, Rainville J, Guermazi A and Katz JN: Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage. 21:1199–1206. 2013. View Article : Google Scholar : PubMed/NCBI
30	Kawu AA, Olawepo A and Salami AO: Facet joints infiltration: A viable alternative treatment to physiotherapy in patients with low back pain due to facet joint arthropathy. Niger J Clin Pract. 14:219–222. 2011. View Article : Google Scholar : PubMed/NCBI
31	Celik B, Er U, Simsek S, Altug T and Bavbek M: Effectiveness of lumbar zygapophysial joint blockage for low back pain. Turk Neurosurg. 21:467–470. 2011.PubMed/NCBI
32	Ribeiro LH, Furtado RN, Konai MS, Andero AB, Rosenfeld A and Natour J: Effect of facet joint injection versus systemic steroids in low back pain: A randomized controlled trial. Spine (Phila Pa 1976). 38:1995–2002. 2013. View Article : Google Scholar : PubMed/NCBI
33	Do KH, Ahn SH, Cho YW and Chang MC: Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain: A randomized controlled trial. Medicine (Baltimore). 96:e65242017. View Article : Google Scholar : PubMed/NCBI