MUJA - MANIPULATION UNDER JOINT ANESTHESIA ANALGESIA - A TREATMENT APPROACH FOR RECALCITRANT LOW-BACK-PAIN OF SYNOVIAL JOINT ORIGIN

Objective: These four cases show how application of manipulation under joint anesthesia/analgesia (MUJA) may benefit the patient with low ba ck pain (LBP) of synovial joint origin when prior treatment options fa il. We propose that MUJA should be considered as a treatment option fo r those with recalcitrant synovial joint-mediated LBP. Clinical Featur es: We report four cases of patients with LBP successfully treated by this protocol. These four patients were neurologically normal and suff ered from lumbar zygapophyseal joint and/or sacroiliac joint mediated pain diagnosed by fluoroscopically guided, contrast enhanced, intra-ar ticular anesthetic injections. There were various radiographic finding s. Intervention and Outcomes: All four individuals were treated with m anipulation after facilitatory intra-articular anesthetic/corticostero id injections into lumbar zygapophyseal and/or sacroiliac joints. Some also required physical therapy interventions to resolve their LBP. Co nclusions: Anecdotal success with MUJA is enticing; MUJA appears to be a viable alternative for those patients in whom traditional treatment options for LBP of synovial joint origin have failed. However, prospe ctive, quality research is required before MUJA can be formally valida ted or not in the treatment of documented lumbar zygapophyseal joint a nd/or sacroiliac joint mediated LBP.