Low Back Pain Clinical Trial
Official title:
Ultrasound-Guided Thermocoagulation of Medial Nerve Branch in Lumbar Facet Joints Pain. Effectiveness and Benefits of a Non Irradiating Technique.
We propose here to evaluate the precision of lumbar thermocoagulation performed under a transverse ultrasound approach by performing a fluoroscopic control once the needle in the desired position. The effectiveness of the technique will be assessed by measuring different pain and disability scores at six weeks post-thermocoagulation: the Visual analogue pain Scale score (VAS) and the Oswestry disability score (ODI) will be collected, compared to that of the conventional fluoroscopic technique.
Low back pain affects 70 to 80% of people at least once in their lives. They have
considerable socio-economic repercussions and represent the leading medical cause of work
stoppage, at around 25% .1
The articular pain between the lumbar vertebrae, called facet joints pain, represent between
15 and 45% of all low back pain and their manifestations are grouped under the name of facet
syndrome including localized pains at the lumbar level as well as pains referred to the
gluteal, trochanteric, inguinal and lateral and posterior region of the thigh. 2-5 The
thermocoagulation of the roots innervating the lumbar facets consists in creating a lesion of
the nerve roots innervating these articulations in order to block the transmission of the
pain.
According to many studies this technique gives good results in 70 to 80% of the cases with an
improvement around 71% to more than six months. 6 A recent Meta-analysis involving 454
patients also shows a significant improvement at 12 months of thermocoagulation versus
placebo and even versus epidural lumbar. 7
To date, Lumbar Thermocoagulation are still mostly performed under fluoroscopic control by
injection of contrast. This technique have proved this effectiveness, but have significant
disadvantages, such as the irradiation of the patient as well as that of the practitioner
because of the number of daily acts performed and its cost.
For its part, ultrasound is easily available, easy to use, represents a lower cost, and the
lack of irradiation. The technique to reach the lumbar facet joints with sonography is pretty
well described and known for many years. 8
We propose here to evaluate the precision of lumbar thermocoagulation performed under a
transverse ultrasound approach by performing a fluoroscopic control once the needle in the
desired position. The effectiveness of the technique will be assessed by measuring different
pain and disability scores at six weeks post-thermocoagulation: the Visual analogue pain
Scale score (VAS) and the Oswestry disability score (ODI) will be collected, compared to that
of the conventional fluoroscopic technique.
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