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International Orthopaedics

, Volume 40, Issue 6, pp 1091–1098 | Cite as

Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial

  • Surachai Sae-JungEmail author
  • Kitti Jirarattanaphochai
Original Paper

Abstract

Purpose

This prospective randomized trial is to determine the effectiveness of treating lumbar facet syndrome with oral diclofenac, methylprednisolone facet joint injection or both.

Methods

We enrolled lumbar facet syndrome patients treated at Srinagarind Hospital. Enrolled patients were randomly assigned to receive 100 mg/day oral diclofenac, an 80 mg injection of methylprednisolone into each symptomatic facet joint, or both. Endpoints were the Oswestry disability index (ODI) and visual analogue scale (VAS) before treatment, and at four and 12 weeks after treatment.

Results

Of the 99 patients, the mean age was 46.4 years and 48 were men. The initial ODI (mean ± SD) for the diclofenac, methylprednisolone and combined treatment was 45.1 ± 9.3, 42.9 ± 15.6, and 42.2 ± 11.5, respectively. The respective four week ODI was 30.1 ± 8.1, 20.2 ± 8.0, and 15.1 ± 5.5. The 12-week ODI was 42.4 ± 9.0, 32.2 ± 15.6, and 26.2 ± 11.7. The initial VAS was 7.1 ± 1.2, 7.6 ± 1.1, and 7.3 ± 1.0. The four week VAS was 5.3 ± 1.4, 3.6 ± 0.7, and 3.3 ± 1.1. The 12-week VAS was 6.1 ± 1.1, 5.8 ± 1.4, and 5.1 ± 0.9. The four week ODI and VAS for the combined treatment and the methylprednisolone treatment were significantly less than the diclofenac alone. The combined treatment also showed better scores than the methylprednisolone injection. Within each treatment, the best treatment effect was found at four weeks after which the ODI and VAS gradually increased but were still less than the initial scores.

Conclusions

The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.

Keywords

Diclofenac Facet joint Facet joint injection Low back pain Methylprednisolone Zygapophyseal joint 

Notes

Acknowledgements

The study was supported by the New Researcher Grant, Khon Kaen University, Khon Kaen, Thailand. The authors would like to acknowledge Mr. Bryan Roderick Hamman and Mrs. Janice Loewen Hamman, for editing the manuscript via Publication Clinic of Khon Kaen University, Thailand.

Compliance with ethical standards

Conflict of interest

The authors have no competing interests.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No benefit(s) in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Disclosure

This is original work from the Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Thailand, and it has not been presented elsewhere nor under consideration by another journal. The authors participated in the design, execution, analysis and writing up of the research.

Supplementary material

264_2016_3154_MOESM1_ESM.pdf (10 kb)
ESM 1 (PDF 9 kb)

References

  1. 1.
    Beresford ZM, Kendall RW, Willick SE (2010) Lumbar facet syndromes. Curr Sports Med Rep 9:50–56CrossRefPubMedGoogle Scholar
  2. 2.
    Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8:396–401CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fritz J, Niemeyer T, Clasen S, Wiskirchen J, Tepe G, Kastler B et al (2007) Mangement of chronic low back pain: rationales, principles, and targets of imaging-guided spinal injections. Radiographics 27:1751–1771CrossRefPubMedGoogle Scholar
  4. 4.
    Cohen SP, Raja SN (2007) Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Aneshtesiology 106:591–614CrossRefGoogle Scholar
  5. 5.
    Mens JM (2005) The use of medication in low back pain. Best Pract Res Clin Rheumatol 19:609–621CrossRefPubMedGoogle Scholar
  6. 6.
    Culling RD, Rice JH (1992) Corticosteroid injections for chronic low back pain. N Engl J Med 326:834CrossRefPubMedGoogle Scholar
  7. 7.
    Helbig T, Lee CK (1988) The lumbar facet syndrome. Spine 13:61–64CrossRefPubMedGoogle Scholar
  8. 8.
    Jackson RP, Jacobs RR, Montesano PX (1988) Facet joint injection in low-back pain: a prospective statistical study. Spine 13:966–971CrossRefPubMedGoogle Scholar
  9. 9.
    Ribeiro LH, Furtado RNV, Konai MS, Andreo AB, Rosenfeld A, Natour J (2013) Effect of facet joint injection versus systemic steroids in low back pain. Spine 23:1995–2002CrossRefGoogle Scholar
  10. 10.
    Eisenstein SM, Parry CR (1987) The lumbar facet arthrosis syndrome:clinical presentation and articular surface changes. J Bone Joint Surg Br 69:3–7PubMedGoogle Scholar
  11. 11.
    Sae-Jung S, Hunzawong T, Jirarattanaphochai K (2002) Reliability of Thai version of Oswestry quesionnaire for the evaluation of low back pain patients. Srinagarind Med J 17:247–253Google Scholar
  12. 12.
    Kalichman L, Hunter DJ (2007) Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum 37:69–80CrossRefPubMedGoogle Scholar
  13. 13.
    Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI (1996) Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech 29:1117–1129CrossRefPubMedGoogle Scholar
  14. 14.
    Gellhorn AC, Katz JN, Suri P (2013) Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 9:216–224CrossRefPubMedGoogle Scholar
  15. 15.
    Pneumaticos SG, Chatziioannou SN, Hipp JA, Moore WH, Esses SI (2006) Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology 238:693–698CrossRefPubMedGoogle Scholar
  16. 16.
    Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M et al (1998) Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia: proposed criteria to identify patients with painful facet joints. Spine 15:1972–1976CrossRefGoogle Scholar
  17. 17.
    Lippitt AB (1984) The facet joint and its role in spine pain: management with facet joint injection. Spine 9:746–750CrossRefPubMedGoogle Scholar
  18. 18.
    Silbergleit R, Mehta BA, Sanders WP, Talati SJ (2001) Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics 21:927–939CrossRefPubMedGoogle Scholar
  19. 19.
    Anand S, Butt MS (2007) Patients' response to facet joint injection. Acta Orthop Belg 73:230–233PubMedGoogle Scholar
  20. 20.
    Hestbaek L, Kongsted A, Jensen TS, Leboeuf-Yde C (2009) The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors. Chiropr Osteopat. doi: 10.1186/1746-1340-17-2 PubMedPubMedCentralGoogle Scholar
  21. 21.
    Simon J, McAuliffe M, Shamim F, Vuong N, Tahaei A (2014) Discogenic low back pain. Phys Med Rehabil Clin N Am 25:305–317CrossRefPubMedGoogle Scholar
  22. 22.
    Freiermuth D, Kretzschmar M, Bilecen D, Schaeren S, Jacob AL, Aeschbach A, Ruppen W (2015) Correlation of (99m) Tc-DPD SPECT/CT scan findings and diagnostic blockades of lumbar medial branches in patients with unspecific low back pain in a randomized-controlled trial. Pain Med 16:1916–1922CrossRefPubMedGoogle Scholar
  23. 23.
    Brummett CM, Cohen SP (2014) Pathogenesis, diagnosis, and treatment of zygapophyseal (facet) joint pain. In: Benzon H, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW (eds) Practical management of pain. Mosby, Philadelphia, pp 816–845CrossRefGoogle Scholar
  24. 24.
    Chang HJ, Lynm C, Glass RM (2010) Osteoarthritis of the lumbar spine. JAMA 304:114CrossRefPubMedGoogle Scholar
  25. 25.
    Chou R (2010) Low back pain (chronic). BMJ Clin Evid 2010:1116PubMedPubMedCentralGoogle Scholar
  26. 26.
    Brand ES, Ky P, Christo PJ, Standaert CJ, Akuthota V (2009) Debating ”interventions“ for chronic axial low back pain. PM R 1:964–972CrossRefPubMedGoogle Scholar
  27. 27.
    Ruiz FK, Bohl DD, Webb ML, Russo GS, Grauer JN (2014) Oswestry disability index is a better indicator of lumbar motion than the visual analogue scale. Spine J 14:1860–1865CrossRefPubMedGoogle Scholar
  28. 28.
    Yavuz U, Sökücü S, Albayrak A, Oztürk K (2012) Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis. Rheumatol Int 32:3391–3396CrossRefPubMedGoogle Scholar
  29. 29.
    Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Gharibo CG, Grami V et al (2015) A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician 18:E535–E582PubMedGoogle Scholar
  30. 30.
    Barr KP, Griggs M, Cadby T (2005) Lumbar stabilization: core concepts and current literature, Part 1. Am J Phys Med Rehabil 84:473–480CrossRefPubMedGoogle Scholar
  31. 31.
    Mars T, Ellard DR, Antrobus JH, Cairns M, Underwood M, Haywood K et al (2015) Intraarticular facet injections for low back pain: design considerations, consensus methodology to develop the protocol for a randomized controlled trial. Pain Physician 18:473–493PubMedGoogle Scholar
  32. 32.
    Chambers H (2013) Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 11:106–120CrossRefPubMedGoogle Scholar
  33. 33.
    Poetscher AW, Gentil AF, Lenza M, Ferretti M (2014) Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 39:E842–E849CrossRefPubMedGoogle Scholar
  34. 34.
    Maas ET, Ostelo RW, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW (2015) Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD008572.pub2 Google Scholar
  35. 35.
    Saltychev M, Laimi K (2014) Re: Poetscher AW, Gentil AF, Lenza M, Ferretti M (2014) Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 39:E1498–E1500CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2016

Authors and Affiliations

  1. 1.Department of Orthopaedics, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand

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