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Effectiveness of Ultrasound-Guided Versus Fluoroscopy or Computed Tomography Scanning Guidance in Lumbar Facet Joint Injections in Adults With Facet Joint Syndrome: A Meta-Analysis of Controlled Trials

  • Author Footnotes
    ∗ Wu and Zhao contributed equally to this work.
    Tao Wu
    Footnotes
    ∗ Wu and Zhao contributed equally to this work.
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Zhe Jiang, PR China
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  • Author Footnotes
    ∗ Wu and Zhao contributed equally to this work.
    Wei-hua Zhao
    Footnotes
    ∗ Wu and Zhao contributed equally to this work.
    Affiliations
    Department of Rehabilitation Medicine, First Hospital of Shi Zui Shan, Ning Xia Medical University, Ning Xia Hui Autonomous Region, PR China
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  • Yan Dong
    Affiliations
    Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang Chinese People's Armed Police Force, Zhe Jiang, PR China
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  • Hai-xin Song
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Zhe Jiang, PR China
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  • Jian-hua Li
    Correspondence
    Corresponding author Jian-hua Li, MD, Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, 3 E Qin Chun Rd, Hangzhou, Zhe Jiang, PR China, 310016.
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Zhe Jiang, PR China
    Search for articles by this author
  • Author Footnotes
    ∗ Wu and Zhao contributed equally to this work.
Published:December 16, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.013

      Abstract

      Objective

      To review the literature and assess the comparative effectiveness of ultrasound-guided (USG) versus computed tomography (CT)–/fluoroscopy-guided lumbar facet joint injections in adults.

      Data Sources

      PubMed, Ovid MEDLINE, Ovid Embase, EBSCO, and Web of Science.

      Study Selection

      Randomized or nonrandomized controlled trials comparing the clinical effectiveness between USG and CT-/fluoroscopy-guided injection techniques in patients with facet syndrome were included.

      Data Extraction

      Two reviewers independently screened abstracts and full texts. The results of the mean procedure duration, decreased pain score, and Modified Oswestry Disability score after treatment were extracted and presented in the form of mean ± SD.

      Data Synthesis

      There were 103 records screened; 3 studies were included, with a total of 202 adults with facet joint pain. There was no statistically significant difference between the 2 groups in pain score and Modified Oswestry Disability score after injection (weighted mean difference [WMD], .07; 95% confidence interval [CI], −.51 to .65; P=.80; I2=78%; WMD, −.55; 95% CI, −1.31 to .22; P=.16; I2=0%, respectively). There was also no statistically significant difference in the mean procedure duration between the 2 groups (standardized mean difference [SMD], .97; 95% CI, −1.01 to 2.94; P=.34; I2=97%).

      Conclusions

      This review suggested that no significant differences in pain and functional improvement were noted between the USG and CT-/fluoroscopy-guided techniques in facet joint injection. USG injection is feasible and minimizes exposure of radiation to patients and practitioners in the lumbar facet joint injection process.

      List of abbreviations:

      CI (confidence interval), CT (computed tomography), RCT (randomized controlled trial), SMD (standardized mean difference), USG (ultrasound-guided), WMD (weighted mean difference)
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