Discussion
Facet syndrome, Facet joints, anxiety, facet joints, LFJ syndrome, fibromyalgia, chronic pain, fibrous, pain, zygapophyseal joints, LMBB, depression, LFJ, LBP
RHEUMATOID ARTHRITIS, MUSCLE WEAKNESS, INFILTRATION, FIBROMYALGIA, LOCAL ANESTHETICS, CHRONIC PAIN, COMPLICATIONS
This prospective randomized study showed that the LMBB under US-guidance is not inferior to FS-guidance. It confirmed the retrospective results of Han et al. [Few patients are no longer taking medications and have psychological follow-up. The pain is not always treated optimally in the “bio-psycho-social” model required for chronic pain. Chronic LBP is often multifactorial and is a major health care problem. Accordingly, more attention should be paid to it in order to avoid depression, anxiety and work stoppage (76% of our patients no longer work), which has a major socio-economic impact and sometimes leads to a sedentary lifestyle causing muscle weakness, eliciting a vicious circle of risk of chronic pain [As a reminder, five vertebrae constituting the lumbar spine are separated anteriorly by the discs which can be a source of pain and posteriorly by the LFJ also called zygapophyseal joints, composed of the superior articular process and inferior articular process. Between these articular processes, lies the synovial membrane, a hyaline cartilage covered by the fibrous capsule within the lumbar spine (Fig. Facet joints of spine’s anatomy. Facet syndrome is a pain that can originate from any structure of the facet joints; fibrous capsule, synovial membrane, hyaline cartilage and boneLMBB is a diagnostic block but can sometimes be considered as therapeutic due to 3.5 months average pain relief of LBP and the significant improvement in functional capacity [Local anesthetics were injected since it blocks the sympathetic reflex arc and the axonal transport inside nerve fibers. Furthermore, it suppresses nociceptive discharge with anti-inflammatory effect. In addition, we use corticosteroids for their anti-inflammatory, immunosuppressive and anti-edematous effects with an inhibitory action of neuronal transmission in the C fibers [Even if US-guidance does not clearly detect a foraminal extent and an intravascular injection, these complications have also been described with the technique by FS-guidance [As limits to our study, we note a small population sample with an age variability implying anatomical distinctions, a relatively short follow-up of 1 month and the different ultrasound and fluoroscopy machines between the centers. More, patients often have other complaints than pain unilateral LFJ syndrome (such as bilateral pain, pain in knees, hips, rheumatoid arthritis, fibromyalgia etc): this lack of homogeneity is certainly unavoidable when considering the types of patients who visit pain clinics. Also, patients report changes in VAPS levels over the course of the day and according to their activities so all of that biases the rating scales. Although thermocoagulation is performed after 2 weeks at Braine-l’Alleud Hospital, it has no influence on the comparison between the two techniques.Despite the benefit of LMBB, there are few articles comparing imaging methods for this infiltration as well as on improving the quality of life of patients after the procedure, which is essential. For future investigations, we propose the comparison of LMBB performed by FS versus US with the US-guidance in a longitudinal axis (as proposed by Chang et al. but not yet validated) which requires only one puncture instead of three, which would be an advantage for patient (faster and less painful) [