Comparison of the Effectiveness of Ultrasound-guided Versus Radioguided Medial Lumbar Bundle Branch Block
Condition: Chronic Low-back Pain; Lumbar Facet Joint Syndrome
MeSH terms: Bundle-Branch Block; Syndrome; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      In adults with chronic low back pain, the investigators will compare the effectiveness of the
      medial bundle branch block on three lumbar levels (L3-L4, L4-L5 and L5-S1) performed either
      by radiographic guidance or by ultrasound approach according to a transverse approach.

      The objective of this study will be to evaluate the benefit of these both procedures on pain,
      on the practice of daily activities and the incidence of adverse events in order to show
      whether the two modalities are equivalent.
    

Detailed description: 
      "Lumbar facet syndrome" is a source of spinal distress affecting up to 45% of patients with
      chronic low back pain due to inflammation, degenerative or arthritic changes, overloading of
      the posterior or posterior lumbar facet joints.

      First-line treatment for the relief of chronic low back pain of zygapophyseal joint origin
      includes bed rest, oral pain relievers / anti-inflammatory drugs, and physiotherapy. If
      unsuccessful, intra-articular injections and medial bundle branch block (BBM) provide
      diagnosis and are an alternative to neurotomy (radiofrequency or cryoneurolysis).

      The BBM targets the medial branches of the posterior twigs, that is, it blocks the
      nociceptors and the muscles of the dermatome undertaken by targeting the medial branches of
      the dorsal vertebral branch supplying a facet above and below the vertebrae which ensure
      sensory innervation of the facet joint. The current standard technique is radiography
      requiring three punctures (transverse-axial plane) and the ultrasound technique is also
      described in this plan and also requires three puncture points. The investigatorswould like
      to compare this promising new technique to the standard radiographic technique since it would
      avoid irradiation and is easier to handle.

      For this study, the investigatorswill compare the BBM on three lumbar levels (L3-L4, L4-L5
      and L5-S1) performed under radiography versus ultrasound according to a transverse approach.

      To compare the equivalence of this two modalities the investigators will evaluate :

        -  the benefit of the procedure on pain (via the visual analogue scale (VAS) collected
           before then at 1 week and at 1 month after the infiltrations)

        -  the evolution of the possibility of carrying out daily activities (via the Duke's
           activity status index (DASI) scale, collected at the same intervals as the VAS)

        -  the limits of daily activities (via the Oswestry Disability Index (ODI), collected at
           the same time intervals)

        -  the incidence of adverse events

      A screening for anxiety and depressive disorders will be also performed before infiltration
      by the Hospital Anxiety and depression scale (HADS) comprising 14 items.
    

Intervention name(s): Ultrasound guided infiltration; Fluoroscopy guided infiltration
Intervention type(s): Other; Other
Intervention description(s): In the patient in prone position, an infiltration guided by ultrasound will be performed in three puncture points (L3-L4, L4-L5 and L5-S1 levels unilaterally). At each level, 1mL of a mixture consisting of 3mL of Linisol 2% (60mg of lidocaine) and 1mL of Depomedrol 40mg / Lidocaine 10mg is injected.; In the patient in prone position, an infiltration guided by fluoroscopy will be performed in three puncture points (L3-L4, L4-L5 and L5-S1 levels unilaterally). At each level, 1mL of a mixture consisting of 3mL of Linisol 2% (60mg of lidocaine) and 1mL of Depomedrol 40mg / Lidocaine 10mg is injected.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Pain; Fluoroscopy; Ultrasound; Injection Site Infiltration; Chronic; Lumbar facet joint syndrome; Medial branch blocks; Disability; Local anesthetic; Lumbalgia; Lumbar zygapophysial joint; Facet syndrome; Chronic Low-back Pain; Medial branch block