Accuracy of the Anatomic Placement in Ultrasonography Guided Facet Joint Blockage with Supervising of C-Arm Fluoroscopy

Abstract

Background: Facet joint blockage is a type of regional anesthesia which is performed selectively on the medial branch of the ramus dorsalis of the spinal nerve and is a current approach for the treatment of pain originating from facet arthropathy. This current approach to chronic low back pain caused by facet joint pathology is usually performed with ultrasound guidance. Objectives: The accuracy of anatomical placement of the facet joint with ultrasonography guidance is determined by C-arm fluoroscopy image taken as reference. Patients and Methods: A total of 22 patients who were diagnosed with facet joint syndrome were involved in the study. After detecting the superolateral corner of the facet joint, which is the target point with ultrasound, the control was provided with C-arm fluoroscopy by giving radiopaque fluid. In order to verify the localization, a mixture of 40 mg triamcinolone and 1 cc 2% lidocaine was injected. Results: Nerve blockage was applied to 67 facet joints at L3-L4, L4-L5 and L5-S1 level in a total of 22 patients (15 female and seven male) diagnosed with facet joint syndrome. The patients' mean age was 63 (range, 48-80), the mean body mass index was 28.4 (range, 18.9-38.1) and the mean time to determine facet localization with ultrasonography (USG) was 240 seconds (range, 140-320). Patients' mean visual analog scale (VAS) decreased from 7 (range, 6-9) to 2.5 (range, 1-6). In the C-arm fluoroscopy control after the injection of radio-opaque material, the needle was found to be located in the lamina in four segments and it was relocated. In addition to this, two facet joints were not localized in ultrasound. This study concluded that the location of the facet joint with USG guidance is possible with 91% sensitivity and 100% positive predictive value when C-arm fluoroscopy was regarded as a gold standard in determining facet joint localization. No complications were observed. Conclusion: The results showed that ultrasonography guided facet joint block can be considered as a minimally invasive procedure that could be easily applied without radiation exposure.

Ultrasound-guided lumbar medial branch blocks and intra-articular facet joint injections: a systematic review and meta-analysis

“…28 One study described confirmation of intra-articular injection with US but did not describe the particular views that were used. 9 Eight studies described an in-plane approach, 13 , 16 , 19 , 25 , 28 , 40 , 54 , 55 and 1 case report described an out-of-plane approach. 41 …”

“…A total of 22 studies met the inclusion and exclusion criteria (Table 1). 3,9,13,14,16,17,[19][20][21]24,25,32,37,40,41,43,47,54,55 Study designs included 6 randomized controlled trials (RCTs), 16,19,25,51,54,55 1 controlled cohort study, 43 9 cohort studies, 3,13,14,21,24,28,32,37,47 1 retrospective comparative study, 20 3 case series, 9,17,40 and 2 case reports. 6,41 Four studies were conference proceedings or abstracts.…”

“…Five RCTs were graded as having some concerns, 16,25,51,54,55 while 1 was graded as high risk of bias because of bias in reporting outcomes. 19 In the nonrandomized studies, 1 was graded as having good quality, 14 8 were graded as having fair quality, 3,13,21,24,28,37,40,43 and 4 were graded as having poor quality. 9,17,32,47 Significant risk of bias related to nonreporting of study data were identified, and most of the studies did not specify an a priori statistical plan.…”

“…9,17,32,47 Significant risk of bias related to nonreporting of study data were identified, and most of the studies did not specify an a priori statistical plan. 3,9,13,17,[19][20][21]24,25,32,37,40,43,47,55 Three studies with high risk of bias because of nonreporting of information were conference abstracts. 9,32,47 Some studies were susceptible to selection bias because of exclusion of patients with obesity.…”

“…Eight studies described a sagittal view to determine the spinal level followed by a transverse view to identify the target facet joint. 13,16,19,25,40,41,54,55 One study described using both longitudinal and transverse views to identify the target with injection performed in-plane in a caudal to cranial trajectory. 28 One study described confirmation of intra-articular injection with US but did not describe the particular views that were used.…”