Ultrasound Guidance for Interventional Pain Management of Lumbar Facet Joint Pain: An Anatomical and Clinical Study

Abstract

Background: There is a growing trend in ultrasound use in interventional pain management. Recently, the ease of use and clinical benefits of lumbar medial branch nerve block under ultrasound guidance have been identified.

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

“…3 , 47 Six studies specified injections performed in-plane from a lateral to medial direction. 6 , 14 , 17 , 21 , 24 , 37 One study described a reorientation of needle direction after performing an L4 MBB, in which the needle was withdrawn and walked medially and caudally while observing progress towards the target for the L5 MBB (intersection of sacral ala and superior articular process) in an out-of-plane fashion. 14 …”

“…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.…”

“…For US-guided MBB, 7 studies described a sagittal approach to identify the spinal level for injection followed by a transverse view to identify the target for final needle placement. 14,17,20,21,24,37,43 One study only described using the transverse view. 32 All studies which specified the target for needle placement described the junction of the cephalad transverse process and the superior articular process 14,17,20,21,24,32,43 which has been shown in a cadaveric and CT-confirmation study as being less specific than targeting a lower point midway between the upper border of the transverse process and the mamilloaccessory ligament.…”