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PSYCHOSOCIOECONOMIC RISK FACTORS IN THE FAILURE OF LUMBAR FACET JOINT

INJECTION IN TREATMENT OF CHRONIC MECHANICAL LOWER BACK PAIN
1,2 2
S. Alemo , A. Sayadipour
1 2
Department of Neurosurgery, Drexel University College of Medicine, University Neurosurgical Pain
Clinic, Philadelphia, PA, USA
Background and aims: The purpose of this study was to identify psychosocioeconomic (PSE) factors in
the patient's history that may have prognostic value in the outcome of lumbar facet joint injection (FJI) for
chronic mechanical lower back pain (CMLBP).

Methods: We conducted a retrospective review of the records of patients with CMLBP who had
undergone FJI. A total of 732 patients were qualified for this study. Information was extracted from the
history and physical by an independent reviewer. Cases were divided into a group with evidence of PSE
issues and a group without. All patients received an injection of methylprednisolone into the L4-5 and
L5/S1 facet joint capsules bilaterally. Each patient was evaluated before and after the procedure at 1
week, 4 weeks, and whenever the pain recurred. The two groups were compared across PSE variables
for success rate (initial favorable response to treatment) and efficacy (duration of pain relief). Drexel
University College of Medicine's Institutional Review Board approved the study.

Results: The combined overall success rate and mean efficacy were 73.2% and 77.9 days, respectively.
In patients with PSE factors, the treatment success rate was 67.9% and mean efficacy was 70.3 days,
and in those without PSE factors, the success rate was 86.8% and the mean efficacy was 88.6 days. A
comparison of success rate and mean efficacy showed a statistically significant difference between
patients with and without PSE issues. A PSE hierarchy including social security disability claims,
psychological disorders, work-related injury, opioid consumption, and personal injuries identified variables
collectively present in the 429 patients with PSE issues.

Conclusions: This retrospective study suggests that assessing PSE variables in the medical history is
helpful for identifying risk factors for FJI treatment failure in patients with CMLBP.