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Home > October Newsletter > Case Series
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| Case History Series: #1: |
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Back Pain - facet joint pain: Part 1 (continued)
RESULTS: INVESTIGATION REPORT:
Medial Branch Block:
Patient: Mr A
Diagnosis: Back Pain for Investigation
Procedural Details: Lumbar medial branch injection:
Under fluoroscopic vision a right L3/4/5 medial branch block was performed with 0.5 ml of Xylocaine 2% per nerve. These nerves supply the L4/5 & L5/S1 facet joints.
Proceduralist: Dr. D Vivian/Dr. Frank Burke
Pain Chart: (score out of 10)
| TIME |
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Back |
Buttock |
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| |
Pre-Block |
5 |
2 |
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| 1:45pm |
5 min |
2 |
1 |
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| 2.15pm |
30 min |
1 |
0 |
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| 2.45pm |
60 min |
1 |
0 |
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| 3.15pm |
90 min |
1 |
0 |
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2 hrs |
1 |
0 |
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3 hrs |
3 |
1 |
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| |
4 hrs |
3 |
1 |
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5 hrs |
3 |
1 |
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6 hrs |
3 |
1 |
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7 hrs |
4 |
1 |
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| Comments:
The injection substantially alleviated the pain. Thus, there is a good chance that the pain he experiences comes from either or both of the lower two facet joints.
Discussion:
Scientific studies have shown that in some instances the positive result on one injection is not reproducible on another injection. This scenario introduces the concept of 'false positive'. The chances of a false positive result are lessened by repeating the test injection procedure with another medication. In this instance, a short acting local anaesthetic drug was used in order to 'block' the pain.
The studies have shown that the chance of a false positive result is 25-35% after the first injection/block and reduces to less than 10% with a concordant second block. So the chance that the result is a true positive is ~ 70% after 1 injection and ~ 90% after a second confirmatory block.
In the next edition of Lowbackpain.TV Guide, we will present the result of the second block.
Then, the diagnosis of pain from the facet joint will be confirmed or rejected.
Previous Page
[Read Part 2 of Case #1...] |
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| Related Video Episodes: |
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 Lumbar Medial Branch Block |
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Lumbar Facet Joint Radiofrequency Neurotomy - Episode 1 |
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 Lumbar Radiofrequency Neurotomy - Episode 2 |
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Sacroiliac Joint Radiofrequency Neurotomy |
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