Comparison of the Effectiveness of Ultrasound-guided Versus Radioguided Medial Lumbar Bundle Branch Block
Chronic Low-back Pain, Lumbar Facet Joint Syndrome
About this trial
This is an interventional treatment trial for Chronic Low-back Pain focused on measuring Pain, Fluoroscopy, Ultrasound, Injection Site Infiltration, Chronic, Lumbar facet joint syndrome, Medial branch blocks, Disability, Local anesthetic, Lumbalgia, Lumbar zygapophysial joint, Facet syndrome, Chronic Low-back Pain, Medial branch block
Eligibility Criteria
Inclusion Criteria:
- Chronic Low-back pain for at least 3 months, without response to a conservative treatment of minimum 4 weeks
- No signs of dissociated pain, radiculitis, neurological diseases (including stroke, Parkinson's disease), spinal instability or deformities (such as scoliosis, ankylosing spondylitis), history of lumbar surgery , fracture or lumbar tumor.
Exclusion Criteria:
- Pregnant or breastfeeding women
- Allergy to injected products (Depomedrol or Linisol)
- Psychiatric disorders hindering understanding of the protocol
- Local or systemic infection
- Coagulation disorder
- Obese with a BMI> 35 kg / m²
Sites / Locations
- Hôpital de Braine l'Alleud Waterloo
- CHU Saint-Pierre
- Hôpital Erasme
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Ultrasound-guided infiltration
Fluoroscopy-guided infiltration
The patient is positioned in the prone position with a block under his stomach. After disinfection of the lumbosacral region with alcoholic chlorhexidine 0.5%, the investigators position the convex probe of the ultrasound machine in the transverse plane. Once the spine has been located, the investigators look for the spinous processes of the lower lumbar vertebrae L4 and L5 with the mark on the cranial side and the side opposite the mark on the side of the sacrum. The latter is visualized as a continuous hyperechoic line. Then, the probe is tilted 90 ° to be in a transverse plane. A 22G needle is introduced in a transverse axis starting from the laterality by inserting it in the direction of the median bone contacts of the lower lumbar vertebrae L3, L4 and L5. An infiltration will be unilaterally performed at three levels (L3-L4, L4-L5 and L5-S1 levels).
The patient is positioned in the prone position with a block under his stomach. The lumbosacral region is disinfected with alcoholic chlorhexidine 0.5%. The C-shaped arm of a X-ray fluoroscopy is positioned around the patient in an antero-posterior view tilted ¾ in order to free the classic view called "scotty dogs ". The puncture point is determined by the positioning of the needle in so-called "tunnel vision". The needle is thus brought to the bone contact corresponding to the eye of the scotty dog in tunnel vision, an area corresponding to the passage of the lumbar median branch. An infiltration will be unilaterally performed at three levels (L3-L4, L4-L5 and L5-S1 levels).