Page 23 - MedicaWell No3

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medica well 23

in cancer patients as well as neuralgic pain, spinal canal stenosis, scoliosis, lumbar spondylolisthesis and low back
pain persisting after lumbar hernia surgery.

It is an advantageous method, as it can be applied under local anesthesia in a short time (3 to 5 minutes) on a special
surgical table using a special imaging device at operating room conditions and the patient can be discharged to
home 1 hour after the injection. Although the term “steroid agent” fears patients, it causes no side effect as it is
used at very small concentrations, excluding some very rare conditions. Patients can engage in routine work life
following 1-day resting at home.

FACET JOINT SYNDROME AND FACET JOINT INJECTION
Facet joint is a real joint between upper and lower articular processes of one vertebra and the other adjacent verte-
bra and it is located at the posterior part of the spinal column. Facet joints ensure strength and anterior and posteri-
or bending and twisting motions. The joint is covered by a thin, superficial cartilage and wrapped by a capsule; the
joint space is filled by synovial fluid (the fluid that nourishes the cartilage and prevents friction between two osse-
ous surface when the spine moves).

There are two principle causes of facet joint injection.
Diagnosis: Determining cause of the pain.
Treatment: Treating the abnormality determined.

A problem in facet joint (such as inflammation, irritation, swell-
ing or arthritis) may cause low back pain. Pains that refer to foot
may mimic the lumbar hernia. Low back pains in advanced age
Low back pain is the second most common disease, may relieve some complaints, but steroid agents in injec- are largely caused by facet joint disorders. Diagnostic tests may
following heart diseases, that causes labor loss. There- tion or pill form cannot be substantially delivered to point to the abnormality in the facet joint and reveal out that the
fore, studies are conducted not only on diagnosis-based cartilages, as there is no vascularization in the torn carti- facet joint is the cause of the pain. It is characterized by aggrava-
treatment, but also on methods that maximize the com- lage. Cartilage tears to the lateral side by 30%. Transfo- tion at night and during immobility. If it is determined that the
fort of life. raminal steroid injection provides good outcomes in true cause of the low back pain is facet joints and if a
those patients. In this method, steroids are directly small dose of local anesthetic agent administered
Low back pain and associating radicular symptoms instilled to the diseased site and exert effects. to the facet joint relieves or eliminates the
(pains that refer to foot) are one of the most serious pain, it points to the fact that the pain is
medical and socioeconomic problems in the present Transforaminal epidural steroid injection is, therefore, an caused by the facet joint. This procedure is
day. Low back pain occurs in 80-85% of adults before important option that is considered among methods diagnostic use of facet joint injection.
the age of 50 years. While 90% of patients with acute preferred for patients with no response to the medical If it is definitely determined that the facet
low back pain recover completely within several weeks, treatment. Moreover, it is also a good method for infec- joint is the cause of the pain, therapeutic
low back pain persists longer than 4 to 6 weeks only in tious neural root diseases, such as Herpes Zoster and injection of anesthetic agents and steroid
10% of patients. For long-standing pains, one should edema and inflammation secondary to tumoral invasion agents may ensure long-standing relief of
considered lumbar disc hernia, tumor, facet joint pain, the pain.
hip joint disorders, lumbar spondylolisthesis and Both procedures are applied in a short
psychological problems. time (5 minutes) in the operating theater
using a special X-ray device and the
The first step of conservative treatment includes exer- patient is discharged to home after the
cises that aim relieving the pain and passive methods procedure.
that include resting and avoidance from lifting heavy
objects. For medication treatment, pain killers and - Transforaminal injection and facet
anti-edema agents as well as muscle relaxants provide joint block are alternative methods that
significant help. A long-term measure is loss of weight. are reserved for persistent low back
The condition persists in a group of patients and neither pain.
surgery nor medication treatment is sufficient whatso- - Better outcomes are obtained, if the
ever the diagnosis is. The major one of those conditions treatment is supported by anti-edema
is lumbar hernia. medicines.
- The gold recommendation includes
LUMBAR HERNIA AND TRANSFORAMINAL INJEC- concomitant weight loss and exercises
TION that strengthen abdominal muscles.
In practice, lumbar hernia is the most common cause of
the low back pain. The cartilage disc located between
two vertebras ruptures and bulges into the spinal canal
and compresses the nerves that innervate legs. The
result is a low back pain followed by foot pain. For Levent Akduygu, M.D.
lumbar hernia cases that are easily diagnosed with MRI, Neurosurgeon
there is no definitely curative medicine. Steroid agents Türkiye Hospital