CT guided Facet Joint Injections

[rosedee]

Has anyone had facet joint injections under CT guidance? I would be interested in any views on the increased accuracy of this in terms of needle placement as opposed to fluoroscopic guidance.

I have had facet joint injections on a number of occasions over the years with no effect. More recently, I had them prior to my ADR, a few days after the ADR and several months after the ADR. All have been negative. All were done under fluoroscopic guidance – the last one under g.a., because the view was better penetration would be gained. A different doctor performed each of these – 2 in the UK (surgeons), I in Germany (a physician who apparently specialised in injections).

My CT scan shows severe facet arthrosis at the level of the ADR to a degree that means everyone has been surprised by the negative effect of injections, in the light of the failure of my ADR to impact on my symptoms at all (I didn’t know anything had been done to my spine at all – the only part of my body that noticed the surgery was my abdomen!).

I have Ehlers Danlos syndrome (diagnosed in 2000), a little known feature of which is an insensitivity to local anaesthesia. This means that it has been realised now that negative diagnostic injections are meaningless.

It has now been suggested to me that I have more facet joint injections, but under CT guidance to ensure more accurate needle placement and using an increased dosage of anaesthetic and ?steroid. I am unsure about this for a number of reasons – a negative result will still not clear my facet joint’s role for sure (because of the EDS) and there is other evidence that questions its role. Finding someone to do this in the UK will not be easy or cheap. So the question is whether it is worth pursuing this or not.

[KBear]

I have never heard of this; but it sounds like it could work. I guess it would be worth a try, especially if your other options are another surgery. Wish I was more help, Kathy

[Justin]

Hi Rosedee,

I just did a quick search and pulled up this publication:

American Journal of Neuroradiology 26:1001-1003, May 2005

Value of CT Fluoroscopy for Lumbar Facet Blocks

LINK to Full-Text

Sherif Melekaa, Ajanta Patrab, Evan Minkoffb and Kieran Murphyc
a Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore MD
b Department of Radiology, Johns Hopkins School of Medicine, Baltimore MD
c Department of Radiology, Johns Hopkins University, Baltimore MD

Address correspondence to Sherif Meleka, MD, Johns Hopkins at Greenspring Station, 2360 West Joppa Road, Suite 206, Lutherville, MD 21093

Summary: We compared the diagnostic accuracy of lumbar facet blocks guided by either conventional fluoroscopy or CT fluoroscopy (CTF). Seventy-one blocks were performed with conventional fluoroscopy, and 58 were performed using CTF. Pain scores were measured before and after the procedure. The CTF group had a greater percentage decrease in pain (79.5% ± 31.1%) than did the conventional fluoroscopy group (55.5% ± 38.0%; P < .0005). We conclude lumbar facet blocks by using CTF guidance results in greater diagnostic accuracy than do conventional fluoroscopy.

© 2005 American Society of Neuroradiology

I think the ED syndrome could be playing into no apparent relief from the facet injections.

I hope this helps.

[rosedee]

Thanks Justin, that's a really useful article for me to read.

Thanks for your post Kathy. The point of doing it would be to indicate whether extending my previous fusion/facet fusion would be helpful. So it's not an alternative to surgery. And that's another whole can of worms!

[Justin]

Good luck! Let me know if you need anything else.

[rosedee]

Hi Justin, That article was really useful - thankyou again.

I've been trying to access the full text of an article about EDS and insensitivity to local anaesthetic. It suggests that it is unlikely that its lack of effect can be compensated for by simply increasing the amount used (Dispersal of radioisotope labelled solution following deep dermal injection in Ehlers-Danlos syndrome. Oliver et al J Plast Surg. 2000 Jun:53 (4): 308- ) As this is so relevant for me at the moment I want to read more than the abstract. Are you (easily) able to access the full text for me? I can only find subscription sites for anything more than the abtrasct. No worries if this is not possible.

[Justin]

Hi Rosedee,

I sent you a PM. Unfortunately, the full-text publication requires a subscription to access (individual publications can be purchased) and is protected by copyright law.