الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Reported prevalence of facet joint mediated pain for patients with chronic low back pain ranges from 8 to 75% in literatures. Imaging modalities are also unable to accurately diagnose facet joint as the source of the low back pain. Although CT can easily identify osteoarthritic changes or the facet joints, the pathology could be their despite normal tomographic appearance. No matter what the symptoms, one characteristic that all patients with facet syndrome have in common is relief of pain from injection of local anaesthetic. Facet joint blocks have traditionally been performed by using fluoroscopic guidance, and this is still the most common method of localization. Our study purpose is to compare between fluoroscopy and computed tomography as image guidance to facet joint block and the medical treatment for lower back pain. The following parameters were used for comparison: pain measurement by the visual analog scale and lumbar range of motion measured by inclinometer. In our study, 146 facet joints were included represented by fifty patients. The age group ranged between 31-57 years old with mean age of 43 years. Studies found in literatures concentrated on the value of facet joint block in diagnosing and eliminating facet mediated pain (4) as well as setting clinical criteria for subjecting patient with low back pain to such an invasive test (83). No previous studies could be found comparing between these two modalities. summary & conclusion 121 Our results showed short-term relief in 88–92% of patients and medium-term relief in 64%, which compare favorably with the results of these earlier studies. In our opinion, the high number of responders in our study could be due to meticulous adherence to the patient selection criteria, with elicitation of paraspinal tenderness over the facet joint being the most important inclusion criterion. The control group which was subjected to medical treatment showed short-term relief in 32%-40% of patients and medium-term relief in 28% with less pain relief in comparison to the experimental group that subjected to injection therapy. Our study showed the correlation between the pain and the range of motion which was inverse correlation, while the pain decrease, the range of motion increase and vice versa. Image-guided facet joint infiltration is a good method for treatment and diagnosis of lumbar facet joint syndrome. It can be repeated and has no severe side effects. For patients with unspecific low back pain, facet joint injections are a very good diagnostic method, allowing definite exclusion of lumbar facet syndrome. Facetal injections are not curative; however, by abolishing pain for periods of up to 6 months they can decrease dependence on oral medications and facilitate early return to work. Since their clinical effect is for a limited duration and wanes after 6 months, they need to be repeated to maintain the pain relief. It is also important to adopt stringent criteria for diagnosing facet joint pain in order to avoid unnecessary and unwarranted injections. In conclusion, we have found that in carefully selected cases, lumbar facet block is a relatively simple, safe, and minimally invasive procedure that can be a valuable adjunct in the treatment of LBP.