Introduction: Lumbar facet joint or Zygapophyseal Joint (ZJ) arthropathy is one of the common causes of low back pain, particularly prevalent at the L3-L4 and L4-L5 levels. Evidence shows the efficacy of Ultrasound Therapy (UST) and intraarticular steroid injections in lumbar facet arthropathy, but there is a paucity of data regarding the comparative efficacy between the two. Aim: To compare the efficacy of fluoroscopy-guided corticosteroid and local anaesthetic injection in the facet joint with UST in cases of L3-L4 and L4-L5 facet arthropathy. Materials and Methods: An interventional cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India, for 18 months, from April 2017 to September 2018. Participants aged between 18 and 70 years with unilateral chronic low back pain due to L3-L4 and L4-L5 facet arthropathy of more than six months duration were included in the study. A total of 17 participants in Group 1 received fluoroscopy-guided corticosteroid and local anaesthetic injections, while Group 2 (also consisting of 17 participants) received UST. Demographic variables such as age and gender, as well as clinical parameters including Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and lumbar range of motion (flexion), were assessed. UST was delivered over the L3-L4 and L4-L5 regions in continuous mode using a frequency of 3.0 MHz at 0.5 W/cm2 , covering an area of approximately 100 cm2 and lasting for 5-10 minutes per session over six continuous days. Comparisons between groups were made using Student’s unpaired t-test, while within-group comparisons were analysed using repeated measures Analysis of Variance (ANOVA) for continuous variables. Fisher’s-exact test was used for categorical variables. A two-tailed p-value of <0.05 was considered statistically significant. Results: The groups were comparable in terms of age and gender distribution. The average ages were 47.76±11.06 years for Group 1 (intra-articular injection) and 48.12±11.35 years for Group 2 (UST). In Group 2, there were statistically significant changes in VAS, ODI and lumbar flexion scores from baseline to two weeks, four weeks and 12 weeks, but not from four weeks to 12 weeks. In the intergroup comparison, a significant improvement in VAS was observed at 12 weeks of follow-up. There was a statistically significant difference in ODI at only 12 weeks (p-value <0.001) of follow-up. A statistically significant difference in lumbar flexion measurements was found at only six weeks of follow-up. Conclusion: Both treatments are efficacious for short-term pain relief (up to four weeks). However, intra-articular facet joint injection demonstrates greater efficacy for long-term pain relief (up to 12 weeks).
Batabyal et al. (Wed,) studied this question.