Lower effectiveness of facet joint infiltration in patients with concurrent facet joint degeneration and active endplate changes

Abstract

Background context: Facet joint degeneration (FJD) and disc degeneration (DD) with associated endplate (EP) changes, specifically Modic 1 changes, might occur concurrently and therefore pose a challenge in the treatment of lower back pain (LBP).

Purpose: The aim of the present study was to investigate if the presence of active EP changes (Modic 1) would alter the effect of facet joint infiltrations (FJI) for the treatment of concurrent FJD.

Study design: Prospective cohort study, Level III.

Patient sample: 42 patients (Male:20, Female:22) with an average of 58±14 years with FJD on conventional magnetic resonance imaging (MRI) receiving a FJI for treatment of lower back pain were included.

Outcome measures: The pain score at baseline, 15 min, 1 day, 1 week and 1 month following FJI as well as the reduction of pain were analyzed. Furthermore, active EP changes on conventional MRI and increased EP metabolic activity on PET/MRI were evaluated and compared.

Methods: All the patients underwent a (18F)-NaF PET/MRI, conventional MRI and FJI for symptomatic FJD. Active EP changes on conventional MRI and increased EP metabolic activity on PET/MR were analyzed for conformity. The pain score as well as the pain reduction at the above-mentioned time points were compared between patients with and without increased EP metabolic activity in PET/MRI.

Results: The LBP reduction was significantly different between patients with (n=20) and without (n=22) active EP changes at 15 minutes (1.3±2.4 vs. 2.9±2.4, p=.03) and 1 month (0.9±2.3 vs. 2.8±2.9, p<.001) following FJI. The minimal clinically important difference for LBP reduction was reached significantly more often in the absence of active EP changes (73%) compared with patients with active EP changes (35%) 1 month following FJI (p=.03).

Conclusions: FJI is less effective in LBP reduction of patients with FJD and concurrent active EP changes (eg Modic 1).

Keywords: (18F)-NaF; Disc degeneration; Facet joint degeneration; Facet joint infiltration; Low back pain; Modic changes; PET/MRI.