this was a direct pars defect repair, im guessing on a youngish girl/woman who still has back pain. the only thing i "might" do is a single intra-articular z joint injection to cool things off. dont go around burning nerves in these young patients. not good long term strategy
or dogma.
From medscape review:
Intra-articular facet joint injection
Numerous early studies of this procedure are not worth mentioning because of their serious flaws with diagnostic criteria, the location of injections, and the injection volumes used. A study by Lynch and Taylor was able to demonstrate that intra-articular injection was superior to extra-articular injection, but, after 6 months of follow-up, the statistical significance had disappeared. [53]
In 1989, Lilius and colleagues prospectively studied 109 patients with chronic LBP. They were distributed randomly into 1 of 3 groups that received injections of intra-articular cortisone/anesthetic, intra-articular saline, or pericapsular cortisone/anesthetic. Although pain relief was substantial, with 36% of patients reporting benefits that persisted for up to 3 months, no significant differences were noted between groups. These results led the authors to conclude that facet joint injection is a nonspecific method of treatment and that good results reflect the tendency of LBP to undergo spontaneous remission. Two critical flaws are noted in this study. First, the authors did not preselect subjects with diagnostic facet joint injections. Second, the intra-articular facet joint injection volumes of up to 8 mL were excessive.
In 1991, a controlled study by Carette and coauthors randomized patients into 2 groups; one group received an intra-articular methyl prednisolone/local anesthetic mixture and the other received intra-articular saline. [26] Patients were preselected with local anesthetic into the facet joints at L4-5 and L5-S1 and reported pain relief of greater than 50%. When the patients were tracked for 6 months, no difference in pain relief was noted between the 2 groups, with the data suggesting that intra-articular facet joint injections with corticosteroids were not effective in treating chronic LBP. This study was flawed in that only a single lidocaine injection, which is subject to false-positive readings and placebo responses, was used to determine the presence of facet joint pain. Furthermore, the assumption that saline is a true inert placebo may be flawed.
Other studies have shown that saline provides pain relief to a greater degree than would be expected from placebo. At 6-month follow-up, 46% of the steroid group and 15% of the saline group had good pain relief; however, the authors invalidated this finding because only a portion of both groups that reported pain relief at 1 month had actual pain relief at 6 months.
A study by Huang indicated that fluoroscopically guided lumbar facet joint injections employing an interlaminar approach and loss-of-resistance technique can provide a successful alternative means of injecting osteoarthritic facet joints, particularly when osteophytes and/or extreme joint curvature in the transverse plane interfere with direct posterior access to severely arthritic joints. [54]
Studies tell is the injection is not a wise choice.
