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Keywords:
Interventional non-vascular, Management, Musculoskeletal spine, CT, Technical aspects
Authors:
S. A. Z. Khodair, E. Mashaly, H. Sameer; Qwuesna/EG
DOI:
10.1594/ecr2015/B-0345
Results
Our study included 120 patients with chronic low back pain on conservative treatment for more than 6 months.
Their mean age was 49 years.
Seventy two ( 60% ) were female while forty eight (40) % were male.
All patients had pain for a period ranged from 2 to 14 years and all used analgesics for at least 12 months.
50% of the patients had radicular pain,
35% had low back pain while 15 % had referred pain.
All patients had back tenderness while only 60% had positive straight leg raising.
Their revised Oswestry disability index before injection ranged from 11 to 38 representing 22% to 76% expressing moderate disability to cripp led.
Plain X-ray films had demonstrated 20% of patients with normal films,
80% had marginal sclerosis and osteophytes formation,
10% showed narrowing of inter-vertebral disc spaces and 15 % showed erosion and sclerosis of sacroiliac joint.
On MRI examination: 70% had degenerative changes of lumbar intervertebral discs.
50% had facet arthropathy,
35% had diffuse posterior lumbar intervertebral disc bulge.
Forty eight patients (40% ) underwent facet joint injection and as most of patients had multi levels of injection,
42 of them were injected at L4-5 level while 36 were injected at L5-S1 level.
Among those 18 patients needed to repeat the injection.
Twelve patients (10%) underwent sacroiliac joint injection,
No one needed to repeat the injection.
Forty two patients (35%) underwent transforamenal perineural injection,
30 of them were injected at L4-5 level and 24 at L5-S1 level,
18 patients of them were injected twice with one month interval.
Eighteen patients (15%) underwent more than one procedure ( 12 patients received simultaneous facet joint injection and transforaminal perineural injection while 6 patients received sacroiliac joint injection with transforaminal injection ( Table 1)
Follow up and outcome: Table (2) and table (3) illustrate Revised Oswestry disability index before,
after 1 week ,
after 1 month of injection for different injection procedures.
Comparison between Revised Oswestry disability index before and after injection was statistically significant in case of facet joint injection ,
nerve root block and sacroiliac joint injection while non significant in patients who received combined modalities of injections .
Table(1):CT guided spinal injections characteristics
Frequency
of injection
|
Level of injection
|
Side of injection
|
Percent
|
Number of cases
|
Injection
Modality
|
Mutiple injection
|
Single injection
|
L5-S1
|
L4-5
|
L3-4
|
L2-3
|
18
|
30
|
36
|
42
|
30
|
6
|
42 unilateral
6 bilateral
|
40%
|
48
|
Facet joint injection
|
-
|
12
|
-
|
-
|
-
|
-
|
6 unilateral
6 bilateral
|
10%
|
12
|
Sacroiliac
Joint injection
|
18
|
24
|
24
|
30
|
18
|
12
|
All unilateral
|
35%
|
42
|
Nerve root block
|
12
|
6
|
12
|
18
|
-
|
-
|
All unilateral
|
15%
|
18
|
Combined injection
|
48
|
72
|
72
|
90
|
48
|
18
|
-
|
100%
|
120
|
Total
|
Table(2):Comparison of Revised Oswestry disability index before ,
after 1 week ,
after 1 month of injection for different injection modalities
Paired t-test
|
Mean ± SD
|
Range of R.O.I
|
Time
|
Injection modality
|
P-value
|
t
|
|
|
26.63±4.00
|
20 - 30
|
Before Injection
|
Facet joint injection
|
˂0.001*
|
6.755
|
15.00±3.78
|
7 - 20
|
1 week after injection
|
˂0.001*
|
7.024
|
14.50±3.25
|
7 – 18
|
1 month after injection
|
|
|
26.29±5.53
|
20 - 37
|
Before Injection
|
Nerve root block
|
0.007*
|
4.061
|
18.14±9.30
|
8 - 37
|
1 week after injection
|
0.007*
|
4.061
|
18.14±9.30
|
8- 37
|
1 month after injection
|
|
|
28.50±0.71
|
28-29
|
Before Injection
|
Sacroiliac joint injection
|
0.042*
|
15.000
|
13.50±2.12
|
12 -15
|
1 week after injection
|
0.042*
|
15.000
|
13.50±2.12
|
12-15
|
1 month after injection
|
|
|
27.67±14.57
|
11-38
|
Before Injection
|
Combined modality injection
|
0.086
|
3.179
|
19.67±12.86
|
5-29
|
1 week after injection
|
0.086
|
3.179
|
19.67±12.86
|
5-29
|
1 month after injection
|
Table (3) : Revised Oswestry disability index for our study population before ,after 1 week and after 1 month of injection
|
ROI
|
Paired t-test
|
Range
|
Mean
|
±
|
SD
|
T
|
P-value
|
Before injection
|
11.0
|
-
|
38.0
|
26.85
|
±
|
6.20
|
|
|
After 1week
|
5.0
|
-
|
37.0
|
16.65
|
±
|
7.39
|
9.064
|
<0.001*
|
After 1month
|
5.0
|
-
|
37.0
|
16.45
|
±
|
7.35
|
9.114
|
<0.001*
|