Lumbar facet joint injection: feasibility as an alternative method in high-risk patients.

OBJECTIVE

To evaluate the effectiveness of therapeutic facet joint steroid injections for symptoms caused by lumbar spinal stenosis in patients who are at risk of bleeding.

METHODS

We analysed 134 patients who had previously undergone one-level bilateral facet joint steroid injections for lumbar radiculopathy caused by spinal stenosis from January 2011 to December 2012. All patients had a bleeding tendency due to several medical conditions. A retrospective chart review was conducted by one radiologist. Response was measured by using a five-point patient satisfaction scale. Evaluations of the relationship between possible outcome predictors were made using the chi-squared or Fisher's exact test, as appropriate.

RESULTS

Among the 42 enrolled patients (male/female = 14/28; mean age, 58 years; range, 41-88 years), 25 patients (59.5 %) were classified to have received effective treatment; in 17 patients treatment was classified as ineffective. Eighteen (72 %) of the 25 patients with mild-to-moderate central canal stenosis had symptom relief, and 7 of the 17 (41.2 %) patients with severe central canal stenosis had symptom relief (P < 0.05). Other outcome predictors were not statistically significant.

CONCLUSION

Therapeutic facet joint steroid injection is potentially effective for lumbar radiculopathy caused by spinal stenosis. This could be helpful in patients at risk of bleeding.

KEY POINTS

• Epidural injection of steroids is a conventional treatment for lumbar radiculopathy. • Facet joint steroid injections showed similar therapeutic effects in lumbar spinal stenosis. • No serious complications, including bleeding, occurred with facet joint injections. • Facet joint steroid injection offers an alternative therapy in patients with bleeding risk.