Steroid Injection in Intra-Articular Lumbar Facet Joint and Lumbar Medial Branch Block Relieve Lower Back Pain

Author: Chris Berrie

Steroid injection into the intra-articular lumbar facet joint (LFJ) and a lumbar medial branch block (MBB) provide good short-term relief of LFJ pain, according to a study presented here at the European Congress of Radiology (ECR).

“Intra-articular steroid injection and MBB are effective and interchangeable techniques in the treatment of LFJ back pain, with good results in the short and medium term and moderate results in the long term,” stated Antonio Izzo, MD, University of L’Aquila, L’Aquila, Italy, on March 3.

Dr. Izzo and colleagues enrolled 57 patients with LFJ back pain and magnetic resonance imaging (MRI)-proven LFJ osteoarthritis and hypertrophy.

The team carried out their analyses on the basis of clinical assessments of severity of LFJ pain (visual analogue scale [VAS], 1-10) and disability grade (Roland-Morris Disability Questionnaire [RMQ]). Clinical effectiveness was defined as a >50% reduction in the pretreatment VAS score and a score of <9 on the RMQ.

The researchers randomised patients to receive intra-articular steroid injections (n = 27) or MBB (n = 30), both under computed-tomography (CT) guidance. All patients received injections of 1.5 mL ropivacaine (7.5 mg/mL) and 2 mL triamcinolone (40 mg/mL).

Overall, the group receiving intraarticular LFJ steroid injections and the group receiving MBB obtained similar rates of clinical effectiveness at 1 month (85.2% vs 86.6%, respectively) and 3 months (77.7% vs 70.0%, respectively). Six months from treatment, intra-articular LFJ steroid injection appeared to provide greater clinical efficacy (66.6% vs 50.0%, respectively).

The team observed similar results for VAS pain score at 1 month (3.8 vs 3.9) and 3 months (4.5 vs 5.0) and saw some improved benefit for intra-articular LFJ steroid injection at 6 months (5.8 vs 6.5).

The RMQ also showed slight improvements in favour of intra-articular LFJ steroid injection from 1 month after treatment (7.9 vs 8.2) to 3 months after treatment (8.8 vs 9.4) and 6 months after treatment (10.7 vs 12.4).

Along with mean age (56.7 vs 55.6 years) and sex (55.6% vs 63.3% female), the patient baseline clinical characteristics were similar across the 2 treatment groups, including for VAS pain (8.1 vs 7.8) and RMQ (16.6 vs 16.1) scores.

Chronic lower back pain often arises from the facet joints, the cartilage-lined points of contact between the articular processes of 2 adjacent vertebrae. This can manifest not only as localised spinal pain but also as pain related to the LFJs, which can induce pain in the back, buttocks, and proximal lower extremities.

LFJ-related pain can be treated with various techniques, including intra-articular steroid injections, MBB, neurolysis of medial branch nerves, or MRI-guided focused ultrasound.

The European Congress of Radiology is sponsored by the European Society for Radiology.

[Presentation title: Intraarticular Facet Joint Steroid Injection vs. Medial Branch Block: Which Technique Ensures Better Clinical Outcome for Managing Lumbar Facet Joint Back Pain? A Single-Centre Experience. Abstract B-1579]