Artikel
Validation of fluoroscopically controlled lumbar facet joint injection using oblique needle technique in degenerative lumbar spine syndrome.
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Veröffentlicht: | 13. Juni 2005 |
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Gliederung
Text
Is the fluoroscopically controlled lumbar facet joint injection (FJI) with local anesthetics a suitable procedure for preoperative diagnosis of symptomatic degenerative facet joint (FJ) disease?
60 patients with degenerative lumbar spine syndrome and radiographic FJ-osteoarthritis (L4/5:29, L5/S1:31) were injected 3 times according to a single blinded randomised trial on one segmental level bilateraly: verum (1.5ml 0.5%-scandicaine), placebo (1.5ml 0.9% sodium-chloride) and with no fluid volume (sicca). Pain level before and after FJI (30,60,150min.) was noted by the patient on a 10pts.-VAS. If pain relief occurs after a FJI, the patient is defined as responder. A responder reacts false positive if the degree of effectiveness of the placebo-FJI is the same or better than the response to LA. A patient reacts false negative if the pain diminution after LA application is lower than after placebo.
30min (60min) after FJI 18% (9%) were non-responder and 51% (70%) verum-responder. The responder-rate for sicca was 44% (47%), for placebo 46% (56%). 32% (21%) reacted false positive after sicca, after placebo it were 25% (19%). False negative reactions after verum could be found in 33% (44%), therefor 26% (32%) compared to placebo and 19% (26%) compared to sicca.
Despite numerous examinations sufficient detection of accurate reliable predictors for positive FJI-responders was not possible till now. This is confirmed by our high non-responder-rate. Placebo responses seem to be highly common. Regarding the criterias specifity and sensitivity, our results indicate, that the only one times diagnostic FJI for verification of a FJ-syndrome has to be declined.