A practice audit of CT-guided injections of pars interarticularis defects in patients with axial low back pain: A primer for further investigation

John T. Wald, Jennifer R. Geske, Felix E. Diehn, Naveen S Murthy, Timothy J Kaufmann, Kent R. Thielen, Jonathan M. Morris, Vance T Lehman, Timothy Maus

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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 Roland-Morris 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.

Original languageEnglish (US)
Pages (from-to)745-750
Number of pages6
JournalPain Medicine (United States)
Volume15
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Low Back Pain
Tomography
Injections
Pain
Adrenal Cortex Hormones
Pain Management
Local Anesthetics
Radiology
Randomized Controlled Trials
Steroids
Placebos
Surveys and Questionnaires

Keywords

  • Corticosteroid
  • CT
  • Injection
  • Pain
  • Pars interarticularis

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

A practice audit of CT-guided injections of pars interarticularis defects in patients with axial low back pain : A primer for further investigation. / Wald, John T.; Geske, Jennifer R.; Diehn, Felix E.; Murthy, Naveen S; Kaufmann, Timothy J; Thielen, Kent R.; Morris, Jonathan M.; Lehman, Vance T; Maus, Timothy.

In: Pain Medicine (United States), Vol. 15, No. 5, 2014, p. 745-750.

Research output: Contribution to journalArticle

@article{c808ecc59c4b46fba801b92c54fb362a,
title = "A practice audit of CT-guided injections of pars interarticularis defects in patients with axial low back pain: A primer for further investigation",
abstract = "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 Roland-Morris 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.",
keywords = "Corticosteroid, CT, Injection, Pain, Pars interarticularis",
author = "Wald, {John T.} and Geske, {Jennifer R.} and Diehn, {Felix E.} and Murthy, {Naveen S} and Kaufmann, {Timothy J} and Thielen, {Kent R.} and Morris, {Jonathan M.} and Lehman, {Vance T} and Timothy Maus",
year = "2014",
doi = "10.1111/pme.12344",
language = "English (US)",
volume = "15",
pages = "745--750",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - A practice audit of CT-guided injections of pars interarticularis defects in patients with axial low back pain

T2 - A primer for further investigation

AU - Wald, John T.

AU - Geske, Jennifer R.

AU - Diehn, Felix E.

AU - Murthy, Naveen S

AU - Kaufmann, Timothy J

AU - Thielen, Kent R.

AU - Morris, Jonathan M.

AU - Lehman, Vance T

AU - Maus, Timothy

PY - 2014

Y1 - 2014

N2 - 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 Roland-Morris 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.

AB - 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 Roland-Morris 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.

KW - Corticosteroid

KW - CT

KW - Injection

KW - Pain

KW - Pars interarticularis

UR - http://www.scopus.com/inward/record.url?scp=84901019300&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901019300&partnerID=8YFLogxK

U2 - 10.1111/pme.12344

DO - 10.1111/pme.12344

M3 - Article

C2 - 24641173

AN - SCOPUS:84901019300

VL - 15

SP - 745

EP - 750

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 5

ER -