Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

Suk Joong Lee; Dae Moo Shim; Chang Su Kim; Sung Kyun Oh; Jae Seon Hwang

doi:10.1874/JKSS.2021.19.4.164

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Lee, Shim, Kim, Oh, and Hwang: Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

Original Research

J Korean Soc Spine Surg 2012;19(4):164-170.

Published online: 18 December 2012

DOI: https://doi.org/10.1874/JKSS.2021.19.4.164

Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

Suk Joong Lee, M.D.^∗, Dae Moo Shim, M.D., Ph.D.^†,^‡,, Chang Su Kim, M.D.^†,^‡, Sung Kyun Oh, M.D.^†,^‡, Jae Seon Hwang, M.D.^†,^‡

^∗Department of Orthopedic Surgery, School of Medicine, Seoul National University Hospital, Seoul, Korea

^{^†}Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea

^{^‡}Institute of Wonkwang Medical Science, Iksan, Korea

Corresponding author: Dae Moo Shim, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 344-2 Shinyong-dong, Iksan, Chunbuk, Korea TEL: 82-63-859-1360, FAX: 82-63-852-9329 E-mail: osshim@wku.ac.kr

Received 21 November 20124 December 2012 Accepted 10 December 2012

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

Level III, retrospective studies.

Objectives

This study is conducted to evaluate the effect and usefulness of ultrasound guided facet block for the outpatients who complained of chronic lower back pain.

Summary of Literature Review

Facet joint syndrome was introduced in 1976, by Mooney V. It was considered to be one of the major causes of low back pain.

Materials and Methods

Between October 2009 to March 2011, 98 cases were selected from the outpatients who complained of chronic lower back pain for more than 3 months. The patients had no surgery history and did not complain of neuromuscular symptoms, and they had more than three times outpatient care at least and could be followed up for 1 year. The patients were divided into three groups; first was the ultrasound guided facet block group (27 cases), second was the Fluoroscopy guided facet block group (39cases) and third was the conservative group (32 cases). The clinical results were analyzed using Kim's criteria and the Visual Analog Scale score, ODI score, Physician's global assessment (subjective), Patient's global assessment (Objective).

Results

The VAS score was improved from an average of 7.75±1.5 to 4.47±2.4 in the ultrasound guided facet block group, and from 7.81±1.4 to 4.39 ±2.6 in the Fluoroscopy guided facet block group, and from 7.87±1.3 to 6.24±2.1 in the conservative group. The VAS score, Kim's criteria, ODI score, Physician's global assessment (subjective), and Patient's global assessment (Objective) showed statistically significant improvement in the ultrasound guided facet block group and Fluoroscopy guided facet block group.

Conclusion

In the outpatient clinics, comparing with the group that underwent conservative treatment with medication, the group treated with ultrasound for block could have better results in clinical improvement.

Keywords: Ultrasound, Facet joint block, Chronic low back pain

REFERENCES

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Fig. 1.

All the procedures were performed with the patient in the prone position. (A) location of the needle at superiolateral edge of the lateral facet. (B) Sonography show facet joint injection.

Table 1.

VAS and Kim's Criteria in Each Group. A. Comparative table of reduced range of VAS score in conservative treatment group & ultrasono-guide facet joint block group.

	Before	3 months F/U	1 year F/U
US guided facet joint injection group (N=27)	7.75 ± 1.5	3.75 ± 2.7	4.47 ± 2.4
Fluoroscopy guided facet joint injection group (N=27)	7.81 ± 1.4	3.76 ± 2.9	4.39 ± 2.6
Conservative Tx with medication (N=32)	7.87 ± 1.3	5.58 ± 2.5	6.24 ± 2.1
Injection VS conservative Tx	0.012	0.021	0.015
P-value	0.012	0.021	0.015
B. Comparative table of reduced range of ∗Kim's Criteria in conservative treatment group & ultrasono-guide facet joint block group.
	Before	3 months F/U	1 year F/U
US guided facet joint injection group (N=27)	1.72 ± 0.4	3.18 ± 0.5	2.97 ± 0.6
Fluoroscopy guided facet joint injection group (N=27)	1.71 ± 0.5	3.19 ± 0.4	3.04 ± 0.7
Conservative Tx with medication (N=32)	1.72 ± 0.4	2.41 ± 0.6	2.08 ± 0.4
Injection VS conservative Tx	0.012	0.018	0.012
P-value	0.012	0.018	0.012

∗Kim's Criteria was converted Score: Poor-1(point), Fair-2(point), Good-3(point), excellent-4(point)

Mean ± SD, N= Number of paitents, (P-value<0.05)

Table 2.

Functional Assessment Evaluated by Oswestry Disability Index, Patient's Global Assessment and Physician's Global Assessment.

A. Oswestry Disability Index

ODI	Before	3 months F/U	1 year F/U
US guided facet joint injection group (N=27)	58 ± 8.47	73 ± 7.68	71 ± 8.82
Fluoroscopy guided facet joint injection group (N=27)	57 ± 9.32	72 ± 8.68	71 ± 7.82
Conservative Tx with medication (N=32)	56 ± 7.45	61 ± 7.88	59 ± 8.33
Injection VS conservative Tx	0.012	0.02	0.032
P-value	0.012	0.02	0.032
B. Patient's Global Assessment
Patient's Global Assessment	Before	3 months F/U	1 year F/U
US guided facet joint injection group (N=27)	2.46 ± 0.65	1.02 ± 0.30	1.25 ± 0.66
Fluoroscopy guided facet joint injection group (N=27)	2.51 ± 0.65	1.11 ± 0.40	1.23 ± 0.74
Conservative Tx with medication (N=32)	2.54 ± 0.66	1.76 ± 0.84	1.56 ± 0.44
Injection VS conservative Tx	0.024	0.024	0.033
P-value	0.024	0.024	0.033
C. Physician's Global Assessment
Physician's Global Assessment	Before	3 months F/U	1 year F/U
US guided facet joint injection group (N=27)	2.53 ± 0.50	1.13 ± 0.23	1.32 ± 0.48
Fluoroscopy guided facet joint injection group (N=27)	2.55 ± 0.56	1.16 ± 0.42	1.31 ± 0.51
Conservative Tx with medication (N=32)	2.62 ± 0.50	1.62 ± 0.21	1.51 ± 0.35
Injection VS conservative Tx	0.013	0.022	0.032
P-value	0.013	0.022	0.032

Mean ± SD, N= Number of paitents, (P-value<0.05)

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