Houston Methodist. Leading Medicine

Lower Spine News

No Benefit Reported from Viscosupplementation of the Spine


Injection of hyaluronic acid (HA) into the knee has been successful in the treatment of knee osteoarthritis. This treatment is called viscosupplementation. It has also been tried in the shoulder, hand, hip, foot, and ankle. In this small (pilot) study, HA injection was used in 13 patients with lumbar facet joint arthritis.

A single injection was given into the affected joint(s) using fluoroscopy. Fluoroscopy is a form of X-ray that allows the surgeon to see inside the spine while inserting and advancing the needle for injection. With this tool, accurate placement of the injection is made possible.

The authors report there was no pain relief or improved function with HA injection of the lumbar spine. Viscosupplementation is an attractive alternative to steroid injections. Steroid injections have not been very successful. But these early results don't support the use of HA injections over steroid injections.

It's possible that viscosupplementation has a place in the treatment of patients with chronic low back pain. The challenge for researchers is to identify who those patients are. And it's also possible that a single HA injection wasn't enough to cause measurable change. Further studies are needed to identify the optimal dose and frequency for this treatment.


May Cleary, MCh, AFRCSI, et al. Viscosupplementation in Lumbar Facet Joint Arthropathy. A Pilot Study. In Journal of Spinal Disorders & Techniques. February 2008. Vol. 21. No. 1. Pp. 29-32.

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