Anesth Pain Med.  2020 Jan;15(1):8-18. 10.17085/apm.2020.15.1.8.

Facet joint injections for management of low back pain: a clinically focused review

• Won HS
• Yang M
• Kim YD

• KMID: 2500449
• DOI: http://doi.org/10.17085/apm.2020.15.1.8

Abstract

Lumbar facet joints have been implicated in chronic low back pain in up to 45% of patients with low back pain (LBP). Facet joint pain diagnosis and management are always challenging for pain physicians. Facet joint pain is not diagnosed by specific demographic features, pain characteristics, or physical findings, even though electrodiagnostic studies and imaging modalities are available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Treatment of chronic LBP arising due to facet joint includes intraarticular injections, medial branch blocks, and radiofrequency neurotomy. However, the evidence of their clinical efficacy is continuously under scrutiny. Pain physicians must have a detailed understanding of the spinal anatomy in order to perform safe and effective interventional procedures. This review outlines the important aspects of spinal anatomy as they relate to interventional pain management related to facet joint injections. Additionally, we provide a comprehensive review of the procedure and clinical evidence.

Keyword

Facet joint injection; Imaging-guided injections; Interventional spinal procedures; Low back pain; Zygapophyseal joint

Figure

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  Fig. 1 Posterior and lateral views of the lumbar vertebrae and their facet joints.

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  Fig. 2 A transverse section of the lumbar facet joint.

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  Fig. 3 The course of the medial branch of posterior ramus from the lumbar spinal nerve. Arrows indicate nerves distributing the facet joint.

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  Fig. 4 Illustration of distribution pattern related to facet joint pain.

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  Fig. 5 A true anteroposterior view of the target segment.

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  Fig. 6 Oblique view of the target segment and “Scotty dog”.

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  Fig. 7 Anteroposterior and lateral view of the facet joint injection.

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  Fig. 8 Needle position and facet joint. Superior or inferior articular processes could be targeted.

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  Fig. 9 Facet joint after contrast injection. Oval shaped or linear streak capsules are shown.

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  Fig. 10 Aberrant contrast leakage into the epidural space during facet joint injection.

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