Injections in the Diagnosis and Treatment of Lumbar Facet Syndrome
Injections in the Diagnosis and Treatment of Lumbar Facet Syndrome
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.
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.
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:

 1. Previous back surgery and other ablative treatments.

 2. Contraindication for the use of corticosteroid or local anesthetic.

 3. Uncontrolled acute or chronic medical illness.

 4. Pregnancy or lactation.

 5. Presence of inflammatory arthropathy or neuropathy.

 6. Wounds or skin lesions in the area.

 7. Diabetes mellitus.

 8. Psychiatric disorders

 9. Refusal to participate in the study.

 10. Demonstration by imaging techniques of other causes that could justify the
 symptomatology.