J Schleifer1, M Kiefer, T Hagen. 1. Institut für Neuroradiologie, Universität des Saarlandes, Homburg/Saar.
Abstract
INTRODUCTION: Lumbar facet joint syndrome is normally based on spondylarthrosis. One of the most common methods of treating it is intra-articular injection of local anaesthetics and cortisone. In this prospective study our goal was to have an objective grading scale to assess the severity of lumbar facet syndrome before and after injection. METHODS: Thirty-two patients were treated by CT-guided intra-articular injections of 0.3 ml bupivacaine and 0.8 ml methylprednisolone. Five different parameters were scored in each patient: (1) finger-ground distance; (2) Schober index (10 cm distance along lumbar spine, difference in cm after flexion of lumbar spine); (3) rotation of lumbar spine; (4) lumbago; (5) pseudoradicular pain. The last two parameters were evaluated by a visual analog score (VAS) with zero for no pain and 10 for worst possible pain. Each parameter was evaluated with one, two or three points. After adding the points, we graded the severity of lumbar facet joint syndrome. RESULTS: Finger-ground distances improved statistically (P<0.05). Schober index and rotation of lumbar spine were not significant. VAS concerning lumbago and pseudoraducular pain were also statistically significant (P<0.001). Thirteen patients remained in the same grade, 18 patients improved by one grade and 1 patient by two grades. DISCUSSION: The grading system presented for assessing lumbar facet joint syndrome is a good parameter to evaluate the severity of the disease and follow-up after injection of local anaesthetics and cortisone. Although they showed no statistical significance, Schober index and rotation of lumbar spine are necessary to evaluate facet syndrome.
INTRODUCTION: Lumbar facet joint syndrome is normally based on spondylarthrosis. One of the most common methods of treating it is intra-articular injection of local anaesthetics and cortisone. In this prospective study our goal was to have an objective grading scale to assess the severity of lumbar facet syndrome before and after injection. METHODS: Thirty-two patients were treated by CT-guided intra-articular injections of 0.3 ml bupivacaine and 0.8 ml methylprednisolone. Five different parameters were scored in each patient: (1) finger-ground distance; (2) Schober index (10 cm distance along lumbar spine, difference in cm after flexion of lumbar spine); (3) rotation of lumbar spine; (4) lumbago; (5) pseudoradicular pain. The last two parameters were evaluated by a visual analog score (VAS) with zero for no pain and 10 for worst possible pain. Each parameter was evaluated with one, two or three points. After adding the points, we graded the severity of lumbar facet joint syndrome. RESULTS: Finger-ground distances improved statistically (P<0.05). Schober index and rotation of lumbar spine were not significant. VAS concerning lumbago and pseudoraducular pain were also statistically significant (P<0.001). Thirteen patients remained in the same grade, 18 patients improved by one grade and 1 patient by two grades. DISCUSSION: The grading system presented for assessing lumbar facet joint syndrome is a good parameter to evaluate the severity of the disease and follow-up after injection of local anaesthetics and cortisone. Although they showed no statistical significance, Schober index and rotation of lumbar spine are necessary to evaluate facet syndrome.