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Home > November Newsletter > Case Series
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| Case History Series: #1: |
Part 2 |
| Back Pain - Facet joint pain: Part 2 (continued)
Patient A:
A 50 year old man presented with a 5 year story of back pain, which had been getting slowly worse.
[Read Part 1]
RESULTS: INVESTIGATION REPORT: Continued
Medial Branch Block:
Patient A has since undergone controlled medial branch blocks in order to ascertain whether or not the pain was from the lower facet joints. These are precision injections performed under x-ray control.
The first block was with Lignocaine 2%. The block was applied to the nerve supply of the lower two facet joints (left L4/5 and L5/S1).
Pain Chart: (score out of 10)
| TIME |
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Back |
|
| 1:45pm |
Pre-Block |
5 |
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| 1:50pm |
5 min |
2 |
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| 2.15pm |
30 min |
1 |
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| 2.45pm |
60 min |
1 |
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| 3.15pm |
90 min |
1 |
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2 hrs |
1 |
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3 hrs |
3 |
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4 hrs |
3 |
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5 hrs |
3 |
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6 hrs |
3 |
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7 hrs |
4 |
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| Comments:
It was considered that this block was positive. There had been an improvement of the pain score of 80%.
A second control block was then performed with Bupivacaine 0.5%.
Pain Chart: (score out of 10)
| TIME |
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Back |
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| 3:15pm |
Pre-Block |
7 |
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| 3:20pm |
5 min |
5 |
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| 3:45pm |
30 min |
3 |
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| 4:15pm |
60 min |
1 |
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| 4:45pm |
90 min |
0 |
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2 hrs |
0 |
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3 hrs |
0 |
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4 hrs |
2 |
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5 hrs |
4 |
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6 hrs |
4 |
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7 hrs |
6 |
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Discussion:
It was also considered that this block was positive. Taken together, these two blocks make the diagnosis of facet joint pain highly likely (more than 90% confidence).
The next step is to proceed to the formal treatment of the facet joints with a radiofrequency neurotomy of the nerve supply to these joints.
In the next edition of Lowbackpain.TV Guide, we will present the results of the radiofrequency neurotomy performed on Patient A..
[Read Part 1: Case History Series #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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