Abstract
Introduction: Analgesia from controlled injections of local anaesthetic into the lumbar zygapohysial joint (z-joint) has been accepted as the standard for diagnosis of z-joint pain. Little is known about the placebo-response rate. Aim of this pilot study is to validate the fluoroscopically controlled z-joint-injection (ZJI) as an instrument for diagnosis of degenerative symptomatic z-joint disease.
Material and Methods: Due to degenerative lumbar spine syndrome 50 z-joints (L5/5: 27; L5/S1 23) were injected three times in a single blinded trial bilaterally. According to a randomisation protocol, using the oblique needle technique the ZJI were done with an local anaesthetic (LA: 1.5 ml 0.5% Scandicain), a saline placebo (sodium: 1.5ml 0.9% NaCl) and with no agent (sicca punction). The pain level before and after the injections (30 min, 1 and 2–3 hours) was documented by the patient on a 10pts.-VAS. Improvement in the pain level after an FJI is defined as responder. A responder reacts false positive if the degree of effectiveness of the placebo-FJI is the same or better than the response to LA. A patient reacts false negative if the pain diminution after LA application is lower than after placebo.
Results: Preliminary results regarding the reactions 30 min after injection are presented. 26% were non-responder and 52.9% LA-responder. The sicca response rate was 38%, for sodium it was 46%. Reaction after sicca-FJI was false positive in 24%, after sodium-FJI in 32% of cases. 38% reacted false negative to LA-injection. The order of the agent application didn’t have significant influence on the responder rates and also not on the extent of contradictory effects.
Conclusions: Despite numerous examinations none could sufficiently evaluate accurate reliable predictors for positive ZJI-responders till now. This is confirmed by our high LA-non-responder-rate of 48.1%. However, only a placebo injection can absolutely exclude a true placebo response. Placebo responses seem to be common. High specificity (minimization of the false positive results) and sensitivity (minimization of the false negative results) are characters for a good diagnostic test. In literature, the specificity of the intraarticular facet block as a diagnostic test for facet joint disease is currently unknown. Capsular rupture with epidural and periarticular diffusion is probably responsible for many false positive findings. Regarding our results, the validity of only one ZJI is not acceptable and shouldn’t be consulted as a diagnostic method for the identification of a facet joint syndrome, therefore. Pain relief after ZJI is a poor predictor of clinical outcome of posterolateral lumbosacral fusions when based on single blocks. Corresponding further examinations are necessary also regarding the ZJI-reliability.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
