The provocative lumbar facet joint

David S Binder, Devi E Nampiaparampil, David S Binder, Devi E Nampiaparampil

Abstract

Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.

Figures

Fig. 1
Fig. 1
Anatomic features in the lumbar spine. Adapted from illustration by Stephen Ponchak MD in Walsh NE. Nociceptive Pain. In Raj PP, editor: Pain Medicine a Comprehensive Review, second ed. Elsevier Science, 2003. With permission
Fig. 2
Fig. 2
Oblique view of the lumbar spine. SAP superior articular process, IAP inferior articular process, P pedicle
Fig. 3
Fig. 3
Pain referral patterns for asymptomatic (normal) and symptomatic (abnormal) patients. From Mooney V. Robertson J. The facet syndrome. Clinical Orthopaedics & Related Research. (115):149–56, 1976 Mar–Apr. Reprinted with permission

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