Image-guided injections for facet joint pain: evidence-based Delphi conjoined consensus paper from the European Society of Musculoskeletal Radiology and European Society of Neuroradiology - Report - MDSpire

Image-guided injections for facet joint pain: evidence-based Delphi conjoined consensus paper from the European Society of Musculoskeletal Radiology and European Society of Neuroradiology

  • By

  • Luca Maria Sconfienza

  • Danoob Dalili

  • Miraude Adriaensen

  • Domenico Albano

  • Georgina Allen

  • Maria Pilar Aparisi Gomez

  • Giacomo Aringhieri

  • Francesco Arrigoni

  • Alberto Bazzocchi

  • Miguel Oliveira Castro

  • Roberto Luigi Cazzato

  • Miriam De Dea

  • Aldo Eros De Vivo

  • Elena Drakonaki

  • Fernando Facal de Castro

  • Dimitrios Filippiadis

  • Jan Fritz

  • Inês Gil

  • Salvatore Gitto

  • Hannes Gruber

  • Harun Gupta

  • Amanda Isaac

  • Andrea S. Klauser

  • Thomas Le Corroller

  • Alexander Loizides

  • Salvatore Marsico

  • Giovanni Mauri

  • Eugene McNally

  • Kalliopi Melaki

  • Carmelo Messina

  • Rebeca Mirón Mombiela

  • Cyprian Olchowy

  • Davide Orlandi

  • Ricardo Moutinho

  • Riccardo Picasso

  • Mahesh Prakash

  • Nicolas Theumann

  • Violeta Vasilevska Nikodinovska

  • Evangelia E. Vassalou

  • Jelena Vucetic

  • David Wilson

  • Federico Zaottini

  • Marcello Zappia

  • Chiara Zini

  • Žiga Snoj

  • May 8, 2025

  • 0 min

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Consensus Recommendations on Image-Guided Injections for Facet Joint Pain Management

Overview

This Delphi study by ESSR and ESNR experts provides evidence-based consensus on image-guided injections for facet joint pain (FJP). Key findings support ultrasound (US) guidance as effective and safe, with comparable outcomes to fluoroscopy and CT guidance, and highlight procedural advantages such as reduced radiation and shorter times for certain approaches.

Background

Chronic back pain is a prevalent cause of disability, with facet joints being a significant but often overlooked pain source, especially in the lumbar spine. Treatment lacks standardization, commonly relying on conservative measures and physician experience. Image-guided injections target facet joint pain locally, potentially improving outcomes and reducing systemic side effects. This study aimed to establish consensus recommendations based on current evidence for image-guided interventions in FJP.

Data Highlights

FindingEvidence LevelKey Outcome
US-guided vs blind lumbar injections2Better clinical outcomes up to 6 weeks with US guidance
MBB with corticosteroid vs local anesthetic onlyRandomized controlled trialsSimilar clinical outcomes up to 2 years
US-guided methylene blue + lidocaine vs corticosteroid + lidocaineProspective RCTBetter pain relief at 3 and 6 months with methylene blue
US-guided vs fluoroscopy-guided cervical MBBRCT and retrospective studiesShorter procedure time, fewer needle passes, no radiation with US
US, fluoroscopy, CT guidance for cervical FJI and MBBRetrospective and prospective studiesNo difference in clinical outcomes up to 6 months
Lateral vs posterior US-guided cervical FJI approachCadaver and imaging studiesLateral approach more accurate (92-100%) than posterior (78%)

Key Findings

  • Ultrasound-guided injections yield better short-term lumbar facet joint pain outcomes than blind injections.
  • Medial branch blocks with corticosteroids provide no significant advantage over local anesthetic alone.
  • US-guided injections of methylene blue and lidocaine are safe and more effective than corticosteroids at 3-6 months.
  • US guidance for cervical medial branch blocks is faster, requires fewer needle passes, and avoids radiation compared to fluoroscopy.
  • Clinical outcomes are similar across US, fluoroscopy, and CT guidance for cervical facet joint injections and medial branch blocks.
  • The lateral US-guided approach for cervical facet joint injections is more accurate than the posterior approach.

Clinical Implications

Clinicians should consider ultrasound guidance for facet joint injections due to its comparable efficacy, procedural efficiency, and safety profile, including the absence of radiation exposure. The choice between corticosteroid and local anesthetic injections can be individualized, as outcomes are similar. The lateral ultrasound approach is preferred for cervical facet joint injections to maximize accuracy.

Conclusion

This consensus supports ultrasound as a reliable, effective, and safe imaging modality for guiding facet joint injections, with evidence-based recommendations to optimize procedural approaches and improve patient outcomes in managing facet joint pain.

References

  1. ESSR & ESNR Delphi Study 2024 -- Consensus Recommendations on Image-guided Injections for Managing Facet Joint Pain

Original Source(s)

Image-guided injections for facet joint pain: evidence-based Delphi conjoined consensus paper from the European Society of Musculoskeletal Radiology and European Society of Neuroradiology

  • by Luca Maria Sconfienza, Danoob Dalili, Miraude Adriaensen, Domenico Albano, Georgina Allen, Maria Pilar Aparisi Gomez, Giacomo Aringhieri, Francesco Arrigoni, Alberto Bazzocchi, Miguel Oliveira Castro, Roberto Luigi Cazzato, Miriam De Dea, Aldo Eros De Vivo, Elena Drakonaki, Fernando Facal de Castro, Dimitrios Filippiadis, Jan Fritz, Inês Gil, Salvatore Gitto, Hannes Gruber, Harun Gupta, Amanda Isaac, Andrea S. Klauser, Thomas Le Corroller, Alexander Loizides, Salvatore Marsico, Giovanni Mauri, Eugene McNally, Kalliopi Melaki, Carmelo Messina, Rebeca Mirón Mombiela, Cyprian Olchowy, Davide Orlandi, Ricardo Moutinho, Riccardo Picasso, Mahesh Prakash, Nicolas Theumann, Violeta Vasilevska Nikodinovska, Evangelia E. Vassalou, Jelena Vucetic, David Wilson, Federico Zaottini, Marcello Zappia, Chiara Zini, Žiga Snoj

  • May 8, 2025

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