Imaging findings predicting the outcome of cervical facet joint blocks

Abstract

To determine which crosssectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJBs.

CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

“…The indirect cervical nerve root injection is similar to the technique used for CT-guided cervical facet joint infiltration [25], except that there is no attempt to place the needle into the joint itself and the non-particulate corticosteroid preparation dexamethasone is used instead of a crystalloid corticosteroid. Serious adverse effects in image-guided cervical facet joint infiltration are rare [26].…”

Osteoarthritis of the spine: the facet joints

“…81–83 Unfortunately, most imaging studies to date have not used reliable and well-developed scales for assessment of FJ OA. Owing to the lack of specificity of FJ OA on imaging, anaesthetic blockade using fluoroscopically guided injections has become standard practice for diagnosing whether a particular joint is producing pain.…”

The effect of facet joint injection on lumbar spinal stenosis with radiculopathy

“… 5 Furthermore, many studies have also reported that the severity of spinal stenosis or facet arthropathy were not related to ESI or FJI effect. 21 , 22 As such further studies for why these treatments are more effective in non-operated patients should be conducted. Neurogenic claudication, a characteristic symptom of spinal stenosis, limits daily lives of patients or their motions and has a great effect on their quality of life.…”