"skipMainNavigation"
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Radiology
Menu
Previous
Next
Original Research

Low Back Pain: Prediction of Short-term Outcome of Facet Joint Injection with Bone Scintigraphy

Published Online:Feb 1 2006https://doi.org/10.1148/radiol.2382041930

Abstract

Purpose: To prospectively evaluate use of bone scintigraphy with single photon emission computed tomography (SPECT) for identification of patients with low back pain who would benefit from facet joint injections.

Materials and Methods: The protocol was reviewed and approved by the institutional review board. All patients provided informed consent. Forty-seven patients (23 men and 24 women) with low back pain, who were scheduled for facet joint injections, were prospectively enrolled and randomized into groups A and B (mean ages, 43.3 and 44.2 years, respectively) with a group A–group B ratio of 2:1. Group A patients underwent bone scintigraphy with SPECT prior to injection. Group A patients with bone scans positive for facet joint abnormalities received injections at the levels where abnormalities were identified on the scan (group A1). Group A patients with negative scans (group A2) received injections at the levels that were decided as in group B. Group B patients received injections at the levels indicated by the referring physician and did not undergo bone scintigraphy. All patients completed a pain and function questionnaire before injection and at 1, 3, and 6 months afterward. The change in the American Academy of Orthopaedic Surgeons pain scores after 1, 3, and 6 months compared with baseline scores was analyzed with analysis of variance and post hoc Bonferroni multiple-comparison tests between groups. Cost analysis was performed.

Results: The change in the pain score at 1 month was significantly higher (P < .004) in group A1 than it was in the other two groups. In group A1, 13 of 15 patients had improvement in pain score of greater than 1 standard deviation at 1 month, whereas improvement occurred in only two of 16 patients in group A2 and five of 16 patients in group B. In patients with positive scans, the number of facets treated with injection was decreased from 60, which was the number originally indicated by the referring physician, to 27. The Medicare cost was reduced from $2191 per patient to $1865 with the use of SPECT.

Conclusion: Bone scintigraphy with SPECT can help identify patients with low back pain who would benefit from facet joint injections.

© RSNA, 2006

References

  • 1 Badgley CE. The articular facets in relation to low back pain and sciatic radiation. J Bone Joint Surg 1941; 23: 481–496.
    Google Scholar
  • 2 Ghormley RK. Low back pain with special reference to the articular facets with presentation of an operative procedure. JAMA 1933;101:1773–1777.
    Google Scholar
  • 3 Goldthwait JE. The lumbosacral articulation: an explanation of many cases of lumbago, sciatica and paraplegia. Boston Med Surg J 1911;164:365–372.
    Google Scholar
  • 4 Ogsbury JS, Schneck SA, Lehman RA. Facet denervation in the treatment of low back pain syndrome. Pain 1977;3:257–263.
    MedlineGoogle Scholar
  • 5 Schwarzer AC, Wang SC, O'Driscoll D, et al. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine 1995;20:907–912.
    MedlineGoogle Scholar
  • 6 Melzack R. The short form McGill pain questionnaire. Pain 1987;30:191–197.
    MedlineGoogle Scholar
  • 7 Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002;84-A(2):208–215.
    MedlineGoogle Scholar
  • 8 Nelemans PJ, de Bie RA, de Vet HCW, Sturmans F. Injection therapy for subacute and chronic benign low-back pain. Cochrane Database Syst Rev. 2005;4. http://www.cochrane.org/reviews/en/ab001824.html. Accessed November 21, 2005.
    Google Scholar
  • 9 Mooney V, Robertson J. The facet syndrome. Clin Orthop Relat Res 1976;115:149–156.
    MedlineGoogle Scholar
  • 10 Lippitt AB. The facet joint and its role in spine pain: management with facet joint injections. Spine 1984;9:746–750.
    MedlineGoogle Scholar
  • 11 Slipman CW, Bhat AL, Gilchrist RV, et al. A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain. Spine J 2003;3:310–316.
    MedlineGoogle Scholar
  • 12 Fairbank JC, Park WM, McCall IW, O'Brien JP. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine 1981;6:598–605.
    MedlineGoogle Scholar
  • 13 Christensen SB. Localization of bone-seeking agents in developing experimentally induced osteoarthritis in the knee joint of the rabbit. Scand J Rheumatol 1983;12:343–349.
    MedlineGoogle Scholar
  • 14 Hutton CW, Higgs ER, Jackson PC, Watt I, Dieppe PA. 99mTc HMDP bone scanning in generalized nodal osteoarthritis. II. The four hour bone scan image predicts radiographic change. Ann Rheum Dis 1986;45:622–626.
    Google Scholar
  • 15 Holder LE, Machlin JL, Asdourian PL, Links JM, Sexton CC. Planar and high resolution SPECT bone imaging in the diagnosis of facet syndrome. J Nucl Med 1995;36:37–44.
    MedlineGoogle Scholar
  • 16 Dolan AL, Ryan PJ, Arden NK, et al. The value of SPECT scans in identifying back pain likely to benefit from the facet joint injection. Br J Rheumatol 1996;35:1269–1273.
    MedlineGoogle Scholar

Article History

Published in print: 2006