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
Year: 2025
Type: article
Abstract: OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided injections for facet joint pain (FJP) and provide clinical indications. METHODS: We report the results of an evidence-based Delphi consensus of 38 experts from the European Society of Musculoskeletal Radiology and the European Society of Neuroradiology, who reviewed the published literature for evidence on image-guided injections for FJP. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when ≥ 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the consensus were used to write the paper. RESULTS: Twenty statements on image-guided FJP treatment have been drafted. Eighteen statements received strong consensus, while two received broad consensus. Three statements reached the highest level of evidence, all of them regarding the lumbar spine. All radiological methods are used for image-guided injections for FJP, and regardless of the radiological method used, all show good safety and efficacy. Facet joint injections and medial branch blocks are used in all spinal regions to treat FJP, and both show similar clinical outcomes. Advanced technological solutions have been studied in the field of lumbar FJP; however, the level of evidence for these is low. CONCLUSION: Despite promising results reported by published papers on image-guided injections for FJP, there is still a lack of evidence on injection efficacy, appropriateness of imaging methods, and optimal medication. KEY POINTS: Question Image-guided injections to treat facet joint pain (FJP) are performed throughout the spine; however, the highest level of evidence exists for the lumbar spine. Findings Regardless of the imaging method used, image-guided injections for facet joint pain treatment are safe, with only minor adverse events in rare cases. Clinical relevance All imaging methods are used for injection guidance to treat FJP, each with advantages and disadvantages. These statements on image-guided injections for FJP provide a concise and up to date overview on the topic, serving as a list of clinical indications.
Source: European Radiology
Authors: 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
Institutions: University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, St Helier Hospital, Epsom and St Helier University Hospitals NHS Trust, Zuyderland Medisch Centrum, University of Oxford, University of Auckland, Auckland District Health Board, University of Pisa, University of L'Aquila, Istituto Ortopedico Rizzoli, Hôpitaux Universitaires de Strasbourg, University of Crete, National and Kapodistrian University of Athens, University General Hospital Attikon, Universitätsklinikum Tübingen, New York University, University of Tübingen, University of Algarve, Innsbruck Medical University, Tirol Kliniken, Leeds Teaching Hospitals NHS Trust, King's College London, Universität Innsbruck, Aix-Marseille Université, Hospital Del Mar, Martin Luther University Halle-Wittenberg, Istituto Ortopedico Gaetano Pini, Herlev Hospital, Gentofte Hospital, Jan Długosz University, Hospital da Luz, Ospedale Policlinico San Martino, Post Graduate Institute of Medical Education and Research, Ss. Cyril and Methodius University in Skopje, University Hospital of Heraklion, University of Molise, Azienda Usl Toscana Centro, Ljubljana University Medical Centre
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,890
Funder: Università degli Studi di Milano
OpenAlex ID: W4410192562