What is the role of intra-articular facet blocks in the management of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Intra-articular injections of the facet joints are advocated by many experts as a method for the diagnosis and treatment of spinal pain. [137, 138] Four studies of intra-articular corticosteroid injections in lumbar spine facet joints [139, 140, 141, 142] and one study in cervical spine joints [143] were performed using comparison groups that were demographically similar to the treatment group but received another treatment.

Two trials were randomized, one by Carette et al involving lumbar facet injections [139] and another by Barnsley et al involving cervical facet injections [143] . Carette et al randomized 101 patients who reported >50% pain relief following a single intra-articular lidocaine block into a group that also received methylprednisolone and a group that didn't. At 1-month follow-up, 42% of the methylprednisolone group and 33% of the saline group reported significant pain relief. However, at 6-month follow-up, a statistically significant comparison was identified; 46% of patients in the methylprednisolone group continued to experience pain relief compared with 15% of the patients in the saline group.

An analysis and synthesis of the evidence by Manchikanti et al excluded other referenced studies that demonstrated significant methodological flaws. [137] Nonrandomized trials and observational studies have shown better results with patient reports of significant long-term pain relief (6 mo) ranging from 28% to 38% to 54%.


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