Facet Syndrome of Lumbar Spine Clinical Trial
Official title:
Comparative Study Between Fluoroscopy Guided Lumbar Facet Joint Injection Versus Ultrasound Guided Injection in Patients With Low Back Pain Due to Facet Syndrome
The aim of this study is to compare the efficacy of fluoroscopy guided lumbar facet joint injection versus ultrasound guided injection in patients with low back pain due to facet syndrome.
All patients will be randomly classified into two equal groups (40 patients each) by using
closed envelops, a computer generated random allocation codes.
Group 1(Fluoroscopy guided group) (n =40 patients):
The patient will be placed in the prone position with a pillow under the abdomen to correct
the lumbar lordosis. The joint to be injected is located and marked, the x ray tube is then
slowly rotated till the joint appear in profile as two parallel lines. After cleaning and
drapping and administration of local anesthesia a22-g spinal needle is inserted in line with
x-ray beam till bony contact is felt. All procedures will be performed under sterile
conditions. Each facet joint is infiltrated with a mixture containing 0.5 ml of 0.25 %
bupivacaine and 0.5 ml (20mg) methylprednisolone acetate injected into the joint.
Group2 (Ultrasound guided group) (n=40 patients):
Patients will be placed in a prone position. Posterior paravertebral parasagittal sonograms
will be obtained to identify of the different spinal levels. The spinous process and adjacent
structures (lamina of the vertebral arch, facet joint, accessory process, and mammillary
process) will be delineated by transverse sonograms at the target level, and the midpoint of
the facet joint space will be established. After cleaning and drapping and administration of
local anesthesia. If the joint is clearly or partially visible, a spinal needle is advanced
under US guidance into the joint space of each lumbar facet joint. The needle is inserted 1-2
cm laterally from the midline at the lateral end of the transducer and precisely positioned
in the US plane at an angle of approximately 45owith respect to the axial plane until the
needle tip reached the target and bony contact is felt. This enables visualization of the
needle, which appears as a bright line-shaped echo pattern on the transverse sonogram. If the
needle placement is correct, a mixture containing 0.5 ml of 0.25 % bupivacaine and 0.5
ml(20mg) methylprednisolone acetate is administered intra-articular (until resistance was
encountered) and injected around the posterior facet joint capsule.
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