Open AccessA Practice Audit of CT ‐Guided Injections of Pars Interarticularis Defects in Patients with Axial Low Back Pain: A Primer for Further Investigation
Author(s) -
Wald John T.,
Geske Jennifer R.,
Diehn Felix E.,
Murthy Naveen S.,
Kaufmann Timothy J.,
Thielen Kent R.,
Morris Jonathan M.,
Lehman Vance,
Maus Timothy P.
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12344
Subject(s) - medicine , pars interarticularis , lumbar , retrospective cohort study , back pain , low back pain , anesthesia , physical therapy , radiology , surgery , spondylolisthesis , spondylolysis , pathology , alternative medicine
Objective To assess whether computed tomography( CT )‐guided injections of local anesthetic and corticosteroid into chronic lumbar pars interarticularis defects may identify and provide benefit to a cohort of patients where the pars defects act as a primary axial pain generator. Design Retrospective practice audit. Setting Single academic radiology pain management practice. Patients 59 consecutive patients undergoing CT ‐guided injections of lumbar pars defects. Methods Patients were assessed with a pain numerical rating scale ( NRS , 0–10) and R oland– M orris disability questionnaire ( R – M ) prior to injection and at 2 weeks and 2 months follow‐up. For categorical outcomes, successful pain relief response was defined as either ≥50% reduction in NRS or pain 0/10; functional response was defined as ≥40% reduction in R – M score. Continuous outcomes (mean NRS , R – M scores) were assessed for significant change following injection. Results For categorical outcomes, 37.9% of patients were responders at 2 months' follow‐up; 20.7 % had complete relief of index pain. For functional recovery, 34.5% were responders at 2 months. Using continuous outcomes, mean NRS was 5.4 ± 2.1 prior to injection and 3.6 ± 2.6 at 2 months ( P < 0.0001). Mean R – M score was 11.7 ± 6.0 prior to injection and 9.0 ± 5.4 at 2 months ( P = 0.001). There were no complications. Conclusions This practice audit suggests that in patients with axial low back pain and chronic pars defects, the pars defects may be implicated as the primary axial pain generator in a small subgroup of patients. Local deposition of corticosteroids into the pars defect may provide significant pain relief in one out of three patients, and complete relief in one out of five patients. This data suggest there may be benefit to pursuing randomized controlled trials of pars injections comparing steroid injection with placebo.