Ultrasound-guided versus low dose computed tomography scanning guidance for lumbar facet joint injections: same accuracy and efficiency

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Abstract

Background

The purpose of this study was to investigate the feasibility, accuracy and efficiency of the facet joint injections in the lumbar spine by ultrasound guided versus lose dose computed tomography (CT) guidance.

Methods

First the examination on the joint space of the facet joints of the lumbar spine was obtained by the ultrasound in 10 patients. Second forty patients were randomized assigned into two groups: ultrasound group and low dose CT group. Comparison was made in the clinical efficiency between the ultrasound-guided group and CT group. The feasibility, accuracy and efficiency of the ultrasound-guided lumbar facet joint injections were also evaluated.

Results

A total of 88 lumbar facet joints from L ₁ to S ₁ were clearly visualized in the 10 patients. Both the ultrasound and the CT measurements showed the same average depth and lateral distance to the reference point ( P > 0.05). And 86.5% of the facet joint injections (64/74) were correctly performed under the ultrasound guidance in the first time. The exact placement of the needle tips was evaluated by CT. After the lumbar facet joint injections, the clinical efficiency was almost the same in the ultrasound-guided group as in the CT group.

Conclusions

The lumbar facet joint space can be accurately demonstrated by ultrasound. The ultrasound-guided facet joint injection in the lumbar spine obtained almost the same satisfactory feasibility, accuracy and clinical efficiency compared with low dose CT. Ultrasound technique could provide the real-time monitoring.

Trial registration

This study was registered on Chinese Clinical Trial Registry ( ChiCTR1800018819, retrospective registered on 11/10/2018).

Related collections

Most cited references 29

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Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain.

N Bogduk, Changguang Wang, A Schwarzer … (1995)

To determine the prevalence of pain arising from the zygapophysial joint in patients with chronic low back pain and to determine whether any clinical features could distinguish patients with and without such pain. Sixty three patients with chronic low back pain were studied prospectively. All patients underwent a detailed history and physical examination as well as a series of intra-articular zygapophysial joint injections of 0.5% bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. They also received injections of normal saline into paraspinal muscles to act as controls. All patients proceeded with the injections. Twenty (32%; 95% confidence interval (CI) 20 to 44%) obtained greater than 50% relief of their pain following the administration of saline. Fifty seven patients completed the study; 23 of them (40%; 95% CI 27 to 53%) failed to obtain relief following the injection of saline but obtained relief following one or more intra-articular injections of local anaesthetic. None of the historical features or clinical tests could discriminate those patients with and those without zygapophysial joint pain. Pain originating from the zygapophysial joint is not uncommon, but this study failed to find any clinical predictors in patients with such pain.

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Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks.

S Kapral, C Weinstabl, H Koinig … (1997)

The use of ultrasound reduces the onset time, improves the quality of sensory block, and minimizes the risks associated with the supraclavicular approach for brachial plexus and stellate ganglion blockade. The present study was designed to evaluate whether ultrasound also facilitates the approach for 3-in-1 blocks. Forty patients (ASA physical status II or III) undergoing hip surgery after trauma were randomly assigned to two groups. In the ultrasound (US) group, 20 mL bupivacaine 0.5% was administered under US guidance, whereas in the control group, the same amount and concentration of local anesthetic was administered with the assistance of a nerve stimulator (NS). After US- or NS-based identification of the femoral nerve, the local anesthetic solution was administered, and the distribution of the local anesthetic solution was visualized and recorded on videotape in the US group. The quality and the onset of the sensory block was assessed by using the pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation on the contralateral leg every 10 min for 60 min. The rating was performed using a scale from 100% (uncompromised sensibility) to 0% (no sensory sensation). Heart rate, noninvasive blood pressure, and oxygen saturation were measured at short intervals for 60 min. The onset of sensory blockade was significantly shorter in Group US compared with Group NS (US 16 +/- 14 min, NS 27 +/- 16 min, P < 0.05). The quality of the sensory block after injection of the local anesthetic was also significantly better in Group US compared with Group NS (US 15% +/- 10% of initial value, NS 27% +/- 14% of initial value, P < 0.05). A good analgesic effect was achieved in 95% of the patients in the US group and in 85% of the patients in the NS group. In the US group, visualization of the cannula tip, the femoral nerve, the major vessels, and the local anesthetic spread was possible in 85% of patients. Incidental arterial puncture (n = 3) was observed only in the NS group. We conclude that an US-guided approach for 3-in-1 block reduces the onset time, improves the quality of the sensory block and minimizes the risks associated with this regional anesthetic technique. The onset time and the quality of a regional anesthetic technique for the lower extremity is improved by ultrasonographic nerve identification compared with older techniques.

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The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain.

Michaël R Laurent, D O'Driscoll, S Wang … (1995)

A prospective cross-sectional analytic study. To assess in patients with chronic low back pain whether the presence or absence of pain originating from the lumbar zygapophysial joints correlates with changes seen on computed tomography. Results of studies have been divided as to whether or not radiologic imaging is able to predict those patients with pain originating from the zygapophysial joints. Sixty-three patients with low back pain lasting for longer than 3 months underwent computed tomography and blocks of the zygapophysial joints at L5-S1, L4-L5, and L3-L4. The zygapophysial joints of all images were scored by three independent, masked radiologists. Interobserver agreement was poor with intraclass correlation coefficients of 0.34-0.66 using total joint scores for all three assessors. Using the results of a repeat assessment with two radiologists there was no statistically significant difference in joint scores between those with and those without pain originating from the zygapophysial joint. Computed tomography has no place in the diagnosis of lumbar zygapophysial joint pain.

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Author and article information

Contributors

Ling Ye: zerodq_hx@163.com

Chuanbing Wen:

ORCID: http://orcid.org/0000-0003-2602-488X

86-28-85422997 , chunbingwen@163.com

Hui Liu: huaxiliuhui@163.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 7 November 2018

Publication date PMC-release: 7 November 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 160

Affiliations

[1 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Department of Pain management, West China Hospital, , Sichuan University, ; Chengdu, Sichuan Province 610041 People’s Republic of China

[2 ]ISNI 0000 0004 1808 0950, GRID grid.410646.1, Department of Pain Management, , Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, ; Chengdu, Sichuan Province 610072 People’s Republic of China

Author information

Chuanbing Wen http://orcid.org/0000-0003-2602-488X

Article

Publisher ID: 620

DOI: 10.1186/s12871-018-0620-7

PMC ID: 6223004

PubMed ID: 30404599

SO-VID: fb547438-0999-4293-ba17-79835c13a1b3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 December 2017

Date accepted : 17 October 2018

Funding

Funded by: National Natural Science Foundation of China

Award ID: 81200865

Award Recipient : Ling Ye

Funded by: Health and Family Planning Commission of Sichuan Province

Award ID: 17PJ370

Award Recipient : Ling Ye

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: ultrasound,computed tomography,accuracy,efficiency,lumbar facet joint injection

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: ultrasound, computed tomography, accuracy, efficiency, lumbar facet joint injection

Ultrasound-guided versus low dose computed tomography scanning guidance for lumbar facet joint injections: same accuracy and efficiency

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Trial registration

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Irish Journal of Paramedicine

Most cited references 29

Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain.

Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks.

The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain.

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