495: Prevalence of Facet pain in Radiologically Diagnosed Prolapsed Disc - Prospective Analytical Study

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Assessment and Measurement of Pain/Nociception, Epidemiology, Treatment/management

Background and Aims: Lowback pain, one of most common health problem - creates substantial burden globally. Disc herniation contributes only small fraction of chronic LBP. Clinical signs-symptoms and imaging abnormalities do not correlate often. In large studies, source of facet joint(s) 24-40%, disc herniation 13-20%, discogenic pain 26%, sacroiliac pain 4-6% and in 13-19% patients cause of pain remained elusive, grouped under non-specific LBP. It is important to emphasize on thorough weighing of clinical and MRI findings when diagnosing LBP.
AIMS: Diagnose & determine the prevalance of facet arthritis as a cause of LBP and confirmation by diagnostic block in MRI proved PIVD patients.

Methods: Prospective analytical study, over 6 months, on patients of chronic LBP, with radiological diagnosis of PIVD, attended OPD - with informed consent, recruited in study maintaining inclusion and exclusion criterias.
Studied 65 patients. 50 patients clinically suspected to have facet arthritis, undergone controlled dual medial branch block (MBB) using 0.3-0.5 ml 2% lignocaine and 0.25% bupivacaine in two different sitting. Positive response defined - atleast 80% reduction of pain and relief from the block should last for at least 2 hours.
Diagnostic MBB positive - Group P; Diagnostic MBB negative - Group N
Prevalence = (No. of Diagnostic MBB positive patients) / Study population X 100

Results: From results and analysis it was seen that there was significant difference of duration of block, post block pain relief (%) and VAS score after lignocaine and bupivacaine among group P and N. Post-block complication was insignificant.

Prevalence of facet joint arthritis in MRI proved PIVD patients =
(Number of patients in Group P/ Number of patients in Group P + Group N) × 100
= (36 ÷ 65) × 100
=55.38
Therefore, calculated prevalence of facet arthritis in MRI proved PIVD patient was 55.38%.

Statistical analysis done using SPSS. p value <0.05 considered significant. Data expressed as mean ± SD as appropriate.

Conclusions: MRI seems to be used for general diagnosis of low-back pain. Symptoms and MRI results correlate poorly, emphasizing the need for thorough weighing of clinical and MRI findings when diagnosing low-back pain. The use of sophisticated imaging in the evaluation of back pain is increasing. Rather, much of spine imaging is often unreasoned and adds no value to the patient’s evaluation.
Clinical correlation with imaging findings is of utmost importance for pinpoint diagnosis and appropriate treatment planning in patients suffering from chronic low back pain.

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Presenting Author: Dr Debolina Ghosh
Submitting Author: Debolina Ghosh

Senior Author: Dr Debolina Ghosh

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr Biplab Sarkar: MD - ESI Institute of Pain Management