Effect of facet joint injections on lumbar axe and clinical findings at the patients with lumbar spinal stenosis

OBJECT To determine lumbar axe deviations of the patients with lumbar spinal stenozis after faceet joint injections and to grove the correlation of reduction between them. METHOD We observed 33 patients with lumbar spinal stenosis who have gone facet joint injection from September 2011 to January 2013 at Department of Neurosurgery, University Hospital of Akdeniz, Antalya. The severity of pain were measured by using Visual Analog Scale (VAS). Lumbar lordosis angles (LLA) and Lumbosacral Angles (LSA) were measured by COBB?s angles technique. Control X-ray were taken at 1. week, 1. month, 2. month, and 6. months after the procedure and the deviation of lumbar lordosis through time were determined. FINDINGS We started our research with 60 patient. But 27 patients were. Out of the study, 11 of them didn?t attemp to routine controls and 16 of them received additional treatments (Additional medication or surgery) during the study. 33 patients were observed till the end of the study. 1) Median severity of pain using VAS prior to the study was found 8,97 while this value of VAS was reduced to 5,64 at 6.month.The lowest VAS value was found to be in the first month after procedure. 2) Prior to procedure we have found the median LLA of the study group patients to be 31,94 degrees. This value was increased by time and at the end of the 2nd month it reached to the highest level of 41,36 degrees. By the 6th month we observed restraightening of the lumbar lordosis. As a result we were able to say that, our treatment had the highest effectivity in first two months. 3) LLA of the patients with lateral stenosis were getting better after injection, but the patients with central stenosis proved no changes. 4) This treatment has shown no benefit to the patients with central stenosis. And the VAS value of these patients were found high. 5) This treatment showed significant healing of LLA at the patients with lateral stenosis. We compare VAS values of patients with lateral stenosis prior to the procedure and the VAS values at the 6th month after the procedure and we were able to prove significance as the p value <0,001. RESULT In our study we observed that, flattened LLA prior to the procedure was improved after injections. Improvement at the LLA correlated with decreased pain. This is the result of corticosteroid treatment which removes nerve root damaging cytokines and pain mediators away from the environment. Decreased edema of the nerve root provides more space for spinal nerves in foramen. That is why it is clearly understood why patients with lateral stenosis showed significant improvement. Pain reduction which was seen through 6 months at the patients with lateral stenosis was temporary. By the time anti-inflammatory effect of the treatment disappeared and the lumbar lordosis returned to it?s former state