Effectiveness of Ultrasonography and Fluoroscopy as a Therapeutic Imaging Modality in the Management of Lumbar Facet Arthropathy: A Prospective Interventional Study

Abstract

Introduction: Lumbar zygopophyseal joint arthropathy is one of the most common causes of low back pain in adults. Historically, C-arm/Fluoroscopy has served as an image guidance tool in intra-articular facet joint injections, however, now ultrasound guidance is also a viable option. Aim: To compare ultrasonography (USG) and fluoroscopy as therapeutic imaging modalities on the basis of time taken for intervention, Visual Analogue Score (VAS) for pain and Oswestry Disability Index (ODI) at 2, 4 and 12 weeks. Materials and Methods: It was a prospective interventional study done with 62 patients who satisfied the inclusion and exclusion criteria and randomly allocated into two groups. Groups were compared on the basis of time taken for intervention, VAS for pain and ODI at 2, 4 and 12 weeks. Independent sample student t-test/Mann-Whitney U test was applied. Confidence Interval (CI) was taken as 95% and p-value <0.05 was considered as statistically significant. Results: Ultrasound group had mean age of 37.75 years (range, 23-55 years) while that of Fluoroscopy group was 40.05 years (range, 20-54 years). Ultrasonography group was quicker by about 135 seconds (2 minutes and 15 seconds) which was statistically significant but there was statistically no difference between the two groups in terms of VAS and ODI at 2 weeks (p=0.107 and 0.893, respectively), 4 weeks (p=0.383 and 0.408, respectively) and 12 weeks (p=0.343 and 0.777, respectively) at 95% CI. Conclusion: Both groups showed significant improvement in pain and disability after 2, 4 and 12 weeks however there were no significant differences in pain and functional improvement between USG guided transverse view and fluoroscopy guided intra-articular lumbar facet joint injection. Therefore, USG guided transverse approach is quicker, feasible and minimises exposure of radiation to patient as well as interventionist.

Keywords

• facet joint pain
• interventional pain management
• intra-articular facet joint injection
• low back pain
• rehabilitation
• radiation exposure