Comparison of the efficacy of anatomical, ultrasound-guided and fluoroscopy-guided intra-articular lumbar facet joint injection: A comparative study

Lumbar facet joint syndrome (LFJS) is a potential cause of chronic lower back pain that can occur by osteoarthritis, spondyloarthritis or trauma. Pain arises with spinal rotation and extension in the lower back, and outer thighs, sometimes pain spreads below the knee joint and increases with sitting-standing activities. Facet joint injections are gaining importance day by day and imaging technique guidance is thought to be safer during joint injection, yet the superiority of fluoroscopy, ultrasound (US) or landmark injections has not been demonstrated for intra-articular injection. Sixty patients from outpatient clinics diagnosed as LFJS were participated in the study. They were randomized into three different groups with equal participants based on intervention; anatomical, US-guided, and fluoroscopy-guided. Pain, functionality and range of lumbar motion were recorded pre-treatment and at first month follow-ups with Visual Analog Scale (VAS) and revised Oswestry Disability Index (rODI), respectively. All groups showed improvement in terms of pain and functionality compared to the baseline. However, VAS and rODI scores of US-guided and fluoroscopy guided groups were significantly lower than anatomical injection group (p<0.001). Changes in flexion direction showed differences between anatomical and US-guided groups (p=0.036). Changes in extension direction were higher in the US-guided group compared to anatomical injection and fluoroscopy-guided groups (p=0.002, p=0.007). Changes in lateral bending were also higher in the US-guided group compared to anatomical injection and fluoroscopy-guided groups (p=0.001, p=0.008). Changes of rotation for the lumbar region were higher in the US-guided and fluoroscopy-guided groups than in the anatomical injection group (p<0.001, p=0.022). Current study showed pain and recovery seem to be superior in the US and fluoroscopy groups.