Injections in the Diagnosis and Treatment of Lumbar Facet Syndrome

Study Overview
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Brief Summary
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In suspected facet joints pain, it is recommended to perform nerve blocks to establish the diagnosis with positive results being and indicator of successful of most permanent treatment of facet pain by rhizolysis. Nevertheless, the usefulness of intraarticular joint injection for diagnosis and prediction of successful neurolysis have been scarcely studied. The main purpose of this trial is to compare both methods, nerve block and intra articular injection, in diagnosis and treatment of facet joints pain.

Detailed Description
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Facet joint pain is considered as a nonspecific cause of spinal pain with an estimated prevalence of 12-61% of the population. At present, there are no unanimous clinical criteria to achieve and accurate diagnosis and the imaging findings do not show a direct correlation with the clinical symptoms. Facet syndrome treatment is also controversial and, although most clinical guidelines recommend nerve block as a diagnostic test, followed by neurolysis as therapeutic technique, there are many detractors of this therapeutic sequence. The confusion is even greater when considering the variability of specialists who perform these techniques, the variability of methods used ranging from blind injections to injections guided by ultrasound, fluoroscopy or CT, or the amount of medication injected. The investigators have long experience in the percutaneous treatment of pain and in the use of different imaging techniques. Although the investigators objectives are multiple, the main one is to know if there are any difference in the outcome of the facet syndrome treated by intra-articular injections and the block of the medial branch of the dorsal branch of the spinal nerve. Along with the collaboration of other specialists the investigators want to address secondary objectives such as the usefulness of ultrasound and fluoroscopy in the treatment of facet syndrome and its comparison with those performed under CT guidance that is considered as the standard technique for its greater precision.

Official Title
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Comparison of Facet Nerve Block Versus Intra-articular Injection in the Diagnosis and Treatment of Lumbar Facet Syndrome

Conditions
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Facet Joint Pain, Facet Syndrome of Lumbar Spine, Facet Joints; Degeneration

Intervention / Treatment
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* Diagnostic Test: FACET JOINT UNDER CT GUIDANCE
* Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE
* Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE
* Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE
* Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE
* Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1- Lumbar facet syndrome diagnosed by the referring specialist: Rehabilitation, Traumatology or Neurosurgery 2 -Mechanical low back pain that increases with rotation and flexion-extension, without radicular irradiation. 3- failure of conservative treatment (pharmacological and physical therapy). 4-Symptoms present more than 3 months Exclusion Criteria: Previous back surgery and other ablative treatments. Contraindication for the use of corticosteroid or local anesthetic. Uncontrolled acute or chronic medical illness. Pregnancy or lactation. Presence of inflammatory arthropathy or neuropathy. Wounds or skin lesions in the area. Diabetes mellitus. Psychiatric disorders Refusal to participate in the study. Demonstration by imaging techniques of other causes that could justify the symptomatology.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: the patients are randomly assigned to intraarticular injection or nerve block
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FACET JOINT UNDER CT GUIDANCE<br>Injection of the facet joint under computed tomography guidance | Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under CT guidance<br>* Other names: ct guidance;Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone in the facet joint under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone in the facet joint under ultrasound guidance<br>* Other names: ultrasound guidance;Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under ultrasound guidance<br>* Other names: ultrasound guidance;|
| Active Comparator: NERVE BLOCK UNDER CT GUIDANCE<br>Injection of the nerve under computed tomography guidance | Diagnostic Test: FACET JOINT UNDER CT GUIDANCE<br>* injection of triamcinolone in the facet joint under CT guidance<br>* Other names: ct guidance;Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone in the facet joint under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone in the facet joint under ultrasound guidance<br>* Other names: ultrasound guidance;Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under ultrasound guidance<br>* Other names: ultrasound guidance;|
| Experimental: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>Injection of the facet joint under fluoroscopy guidance | Diagnostic Test: FACET JOINT UNDER CT GUIDANCE<br>* injection of triamcinolone in the facet joint under CT guidance<br>* Other names: ct guidance;Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under CT guidance<br>* Other names: ct guidance;Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone in the facet joint under ultrasound guidance<br>* Other names: ultrasound guidance;Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under ultrasound guidance<br>* Other names: ultrasound guidance;|
| Active Comparator: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>Injection of the nerve under ultrasound guidance | Diagnostic Test: FACET JOINT UNDER CT GUIDANCE<br>* injection of triamcinolone in the facet joint under CT guidance<br>* Other names: ct guidance;Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under CT guidance<br>* Other names: ct guidance;Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone in the facet joint under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone in the facet joint under ultrasound guidance<br>* Other names: ultrasound guidance;Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under ultrasound guidance<br>* Other names: ultrasound guidance;|
| Experimental: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>Injection of the facet joint under ultrasound guidance | Diagnostic Test: FACET JOINT UNDER CT GUIDANCE<br>* injection of triamcinolone in the facet joint under CT guidance<br>* Other names: ct guidance;Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under CT guidance<br>* Other names: ct guidance;Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone in the facet joint under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under ultrasound guidance<br>* Other names: ultrasound guidance;|
| Active Comparator: NERVE BLOCK UNDER ULTRASOUND GUIDANCE<br>Injection of the nerve under computed ultrasound guidance | Diagnostic Test: FACET JOINT UNDER CT GUIDANCE<br>* injection of triamcinolone in the facet joint under CT guidance<br>* Other names: ct guidance;Diagnostic Test: NERVE BLOCK UNDER CT GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under CT guidance<br>* Other names: ct guidance;Diagnostic Test: FACET JOINT UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone in the facet joint under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: NERVE BLOCK UNDER FLUOROSCOPY GUIDANCE<br>* injection of triamcinolone around the dorsal ramus under fluoroscopy guidance<br>* Other names: fluoroscopy guidance;Diagnostic Test: FACET JOINT UNDER ULTRASOUND GUIDANCE<br>* injection of triamcinolone in the facet joint under ultrasound guidance<br>* Other names: ultrasound guidance;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain (VAS score) | score from no pain (0) to maximum pain (10) | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oswestry scale | score from no disability(0) to maximum disability (10) | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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FACET JOINTS, FACET INJECTIONS, NERVE BLOCK