Benefits of Lumbar Facet Joint Block For Persistent Backache After Lumbar Discectomy An Analysis of 58 Patients

Object:  The author evaluated the effectiveness of using facet joint block with local anesthetic agents and steroid medication for the treatment of persistent low-back pain in a medium-sized series of patients who underwent lower lumbar disc surgery. Methods:  Over a period of 2 years, the author performed 130 facet joint injections in 58 patients with persistent low-back pain after lumbar discectomies at L3/4, L4/5 and L5/S1 levels in Combined Military Hospital Rawal-pindi. All of the 21 women and 37 men (mean age 44 years, range 23 to 68) entered into the trial had low back pain for over one month localised to one side with tenderness and local muscle spasm over the facet joints. All had a negative straight-leg-raising test but 17 had slight pain radiating into the posterior thigh on the same side where surgery was performed. The main parameter for the success or failure of this treatment was the relief of the pain. For the first injection mainly a diagnostic procedure the author used a local anesthetic (1 ml bupivacaine 1%). In cases of good response, Depomedral 80 mg was injected in a second session to achieve a longer-lasting effect. Long-lasting relief of the low-back pain was reported by 43 patients (74%) during a mean follow-up period of 10 months. Nine patients (15.2%) noticed a general improvement in their pain. Six patients (10%), however, experienced no improvement of pain at all. There were no cases of infection or hematoma. Conclusions:  Lumbar facet joint block is a minimally invasive procedure to treat facet joint pain in post discec-tomy period. The procedure also seems to be useful for distinguishing between facet joint pain from postoperative pain due to inappropriate neural decompression after lumbar surgery