eMedicine Specialties > Physical Medicine and Rehabilitation > Lumbar Spine Disorders

Lumbar Facet Arthropathy: Multimedia

Author: Carl H Shin, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Coauthor(s): Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Contributor Information and Disclosures

Updated: Mar 3, 2009

Multimedia

Anteroposterior view of right L4-5 facet intra-ar...Media file 1: Anteroposterior view of right L4-5 facet intra-articular injection with contrast.
Anteroposterior view of right L4-5 facet intra-ar...

Anteroposterior view of right L4-5 facet intra-articular injection with contrast.

Lateral view of right L4-5 facet intra-articular ...Media file 2: Lateral view of right L4-5 facet intra-articular injection with contrast.
Lateral view of right L4-5 facet intra-articular ...

Lateral view of right L4-5 facet intra-articular injection with contrast.

Oblique view of right L4-5 facet intra-articular ...Media file 3: Oblique view of right L4-5 facet intra-articular injection with contrast.
Oblique view of right L4-5 facet intra-articular ...

Oblique view of right L4-5 facet intra-articular injection with contrast.

Anteroposterior view of right L5 dorsal medial br...Media file 4: Anteroposterior view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala).
Anteroposterior view of right L5 dorsal medial br...

Anteroposterior view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala).

Lateral view of right L5 dorsal medial branch nee...Media file 5: Lateral view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala, just below the L5-S1 facet joint).
Lateral view of right L5 dorsal medial branch nee...

Lateral view of right L5 dorsal medial branch needle position (tip of the needle is at the neck of the sacral ala, just below the L5-S1 facet joint).

Anteroposterior view of right L4 dorsal medial br...Media file 6: Anteroposterior view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process).
Anteroposterior view of right L4 dorsal medial br...

Anteroposterior view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process).

Lateral view of right L4 dorsal medial branch nee...Media file 7: Lateral view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process, just below L4-5 facet joint).
Lateral view of right L4 dorsal medial branch nee...

Lateral view of right L4 dorsal medial branch needle position (tip of the needle is at the neck of the right L5 transverse process, just below L4-5 facet joint).

More on Lumbar Facet Arthropathy

Overview: Lumbar Facet Arthropathy
Differential Diagnoses & Workup: Lumbar Facet Arthropathy
Treatment & Medication: Lumbar Facet Arthropathy
Follow-up: Lumbar Facet Arthropathy
Multimedia: Lumbar Facet Arthropathy
References

References

  1. Badgley CE. The articular facet in relation to low back pain and sciatic radiation. J Bone Joint Surg. 1941;23:481.

  2. Ghormley RK. Low-back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA. 1933;101:1773-7.

  3. Rees WS. Multiple bilateral subcutaneous rhizolysis of segmental nerves in the treatment of intervertebral disc syndrome. Ann Gen Prac. 1972;26:126.

  4. Shealy CN. Facets in back and sciatic pain. A new approach to a major pain syndrome. Minn Med. Mar 1974;57(3):199-203. [Medline].

  5. Hirsch C, Ingelmark BE, Miller M. The anatomical basis for low back pain. Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine. Acta Orthop Scand. 1963;33:1-17. [Medline].

  6. Mooney V, Robertson J. The facet syndrome. Clin Orthop Relat Res. Mar-Apr 1976;(115):149-56. [Medline].

  7. McCall IW, Park WM, O''Brien JP. Induced pain referral from posterior lumbar elements in normal subjects. Spine. Sep-Oct 1979;4(5):441-6. [Medline].

  8. Marks R. Distribution of pain provoked from lumbar facet joints and related structures during diagnostic spinal infiltration. Pain. Oct 1989;39(1):37-40. [Medline].

  9. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. Apr 1991;22(2):181-7. [Medline].

  10. Ashton IK, Ashton BA, Gibson SJ, et al. Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res. Jan 1992;10(1):72-8. [Medline].

  11. Giles LG, Harvey AR. Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J Rheumatol. Oct 1987;26(5):362-4. [Medline].

  12. Grönblad M, Korkala O, Konttinen YT, et al. Silver impregnation and immunohistochemical study of nerves in lumbar facet joint plical tissue. Spine. Jan 1991;16(1):34-8. [Medline].

  13. Adams MA, Hutton WC. The effect of posture on the role of the apophysial joints in resisting intervertebral compressive forces. J Bone Joint Surg Br. Aug 1980;62(3):358-62. [Medline][Full Text].

  14. Schmidt H, Heuer F, Wilke HJ. Interaction between finite helical axes and facet joint forces under combined loading. Spine. Dec 1 2008;33(25):2741-8. [Medline].

  15. Jackson RP, Jacobs RR, Montesano PX. 1988 Volvo award in clinical sciences. Facet joint injection in low-back pain. A prospective statistical study. Spine. Sep 1988;13(9):966-71. [Medline].

  16. Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. Oct 3 1991;325(14):1002-7. [Medline].

  17. Schwarzer AC, Aprill CN, Derby R, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. Aug 1994;58(2):195-200. [Medline].

  18. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity?. Spine. May 15 1994;19(10):1132-7. [Medline].

  19. Moran R, O''Connell D, Walsh MG. The diagnostic value of facet joint injections. Spine. Dec 1988;13(12):1407-10. [Medline].

  20. Schwarzer AC, Wang S, Laurent R, et al. The role of the zygapophysial joint in chronic low back pain [abstract]. Aust NZ J Med. 1992;22:185.

  21. Schwarzer AC, Wang SC, Bogduk N, et al. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis. Feb 1995;54(2):100-6. [Medline][Full Text].

  22. Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. May 28 2004;5:15. [Medline][Full Text].

  23. Raymond J, Dumas JM. Intraarticular facet block: diagnostic test or therapeutic procedure?. Radiology. May 1984;151(2):333-6. [Medline][Full Text].

  24. Revel ME, Listrat VM, Chevalier XJ, et al. Facet joint block for low back pain: identifying predictors of a good response. Arch Phys Med Rehabil. Sep 1992;73(9):824-8. [Medline].

  25. Manchikanti L, Manchikanti KN, Cash KA, et al. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician. Jan 2008;11(1):67-75. [Medline][Full Text].

  26. Kalichman L, Li L, Kim DH, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine. Nov 1 2008;33(23):2560-5. [Medline].

  27. Dory MA. Arthrography of the lumbar facet joints. Radiology. Jul 1981;140(1):23-7. [Medline][Full Text].

  28. Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine. Oct 1984;9(7):746-50. [Medline].

  29. Carrino JA, Lurie JD, Tosteson AN, et al. Lumbar spine: reliability of MR imaging findings. Radiology. Jan 2009;250(1):161-70. [Medline].

  30. Schwarzer AC, Wang SC, O'Driscoll D, et al. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine. Apr 15 1995;20(8):907-12. [Medline].

  31. Cohen SP, Hurley RW. The ability of diagnostic spinal injections to predict surgical outcomes. Anesth Analg. Dec 2007;105(6):1756-75, table of contents. [Medline].

  32. Lord SM, Barnsley L, Wallis BJ, et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine. Aug 1 1996;21(15):1737-44; discussion 1744-5. [Medline].

  33. Barnsley L, Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. Nov-Dec 1993;18(6):343-50. [Medline].

  34. Dreyfuss P, Schwarzer AC, Lau P, et al. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine. Apr 15 1997;22(8):895-902. [Medline].

  35. Kroll HR, Kim D, Danic MJ, et al. A randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome. J Clin Anesth. Nov 2008;20(7):534-7. [Medline].

  36. Lynch MC, Taylor JF. Facet joint injection for low back pain. A clinical study. J Bone Joint Surg Br. Jan 1986;68(1):138-41. [Medline][Full Text].

  37. Gallagher J, Petriccioone di Vadi PL, Wedley JR. Radiofrequency facet joint denervation in the treatment of low back pain: a prospective controlled double-blind study to assess its efficacy. Pain Clin. 1994;7(3):193-8.

  38. van Kleef M, Barendse GA, Kessels A, et al. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine. Sep 15 1999;24(18):1937-42. [Medline].

  39. Dreyfuss P, Halbrook B, Pauza K, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. May 15 2000;25(10):1270-7. [Medline].

  40. Leclaire R, Fortin L, Lambert R, et al. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine. Jul 1 2001;26(13):1411-6; discussion 1417. [Medline].

  41. van Wijk RM, Geurts JW, Wynne HJ, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain. Jul-Aug 2005;21(4):335-44. [Medline].

  42. Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine. Nov 1 2004;29(21):2471-3. [Medline].

  43. Kornick C, Kramarich SS, Lamer TJ, et al. Complications of lumbar facet radiofrequency denervation. Spine. Jun 15 2004;29(12):1352-4. [Medline].

  44. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. Oct 1993;55(1):99-106. [Medline].

  45. Beaman DN, Graziano GP, Glover RA, et al. Substance P innervation of lumbar spine facet joints. Spine. Jun 15 1993;18(8):1044-9. [Medline].

  46. Blanchard J, Ramamurthy S, Walsh N, et al. Intravenous regional sympatholysis: a double-blind comparison of guanethidine, reserpine, and normal saline. J Pain Symptom Manage. Dec 1990;5(6):357-61. [Medline].

  47. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. Mar 1990;72(3):403-8. [Medline].

  48. Bogduk N, Schwarzer A. Facet joint pain. Aust Fam Physician. May 1995;24(5):924. [Medline].

  49. Borenstein D. Does osteoarthritis of the lumbar spine cause chronic low back pain?. Curr Pain Headache Rep. Dec 2004;8(6):512-7. [Medline].

  50. Carrera GF, Williams AL. Current concepts in evaluation of the lumbar facet joints. Crit Rev Diagn Imaging. 1984;21(2):85-104. [Medline].

  51. Dolan AL, Ryan PJ, Arden NK, et al. The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. Br J Rheumatol. Dec 1996;35(12):1269-73. [Medline][Full Text].

  52. Dreyfuss PH, Dreyer SJ, Herring SA. Lumbar zygapophysial (facet) joint injections. Spine. Sep 15 1995;20(18):2040-7. [Medline].

  53. Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br. Nov 1984;66(5):706-10. [Medline][Full Text].

  54. Eubanks JD, Lee MJ, Cassinelli E, et al. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine. Sep 1 2007;32(19):2058-62. [Medline].

  55. Fairbank JC, Park WM, McCall IW, et al. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine. Nov-Dec 1981;6(6):598-605. [Medline].

  56. Frost FA, Jessen B, Siggaard-Andersen J. A control, double-blind comparison of mepivacaine injection versus saline injection for myofascial pain. Lancet. Mar 8 1980;1(8167):499-500. [Medline].

  57. Helbig T, Lee CK. The lumbar facet syndrome. Spine. Jan 1988;13(1):61-4. [Medline].

  58. Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. Jan 1966;25(1):1-24. [Medline].

  59. Lewinnek GE, Warfield CA. Facet joint degeneration as a cause of low back pain. Clin Orthop Relat Res. Dec 1986;(213):216-22. [Medline].

  60. Lilius G, Laasonen EM, Myllynen P, et al. Lumbar facet joint syndrome. A randomised clinical trial. J Bone Joint Surg Br. Aug 1989;71(4):681-4. [Medline].

  61. Magora A. Relation between the low back pain syndrome and x-ray findings. Scand J Rehabil Med. 1976;8:115-25.

  62. Murtagh FR. Computed tomography and fluoroscopy guided anesthesia and steroid injection in facet syndrome. Spine. Jun 1988;13(6):686-9. [Medline].

  63. Panjabi MM, Goel VK, Takata K. Physiologic strains in the lumbar spinal ligaments. An in vitro biomechanical study 1981 Volvo Award in Biomechanics. Spine. May-Jun 1982;7(3):192-203. [Medline].

  64. Raymond J, Dumas JM, Lisbona R. Nuclear imaging as a screening test for patients referred for intraarticular facet block. J Can Assoc Radiol. Sep 1984;35(3):291-2. [Medline].

  65. Weishaupt D, Zanetti M, Hodler J, et al. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology. Dec 1998;209(3):661-6. [Medline][Full Text].

  66. Wiesel SW, Tsourmas N, Feffer HL, et al. A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine. Sep 1984;9(6):549-51. [Medline].

  67. Wilde VE, Ford JJ, McMeeken JM. Indicators of lumbar zygapophyseal joint pain: survey of an expert panel with the Delphi technique. Phys Ther. Oct 2007;87(10):1348-61. [Medline].

  68. Willburger RE, Wittenberg RH. Prostaglandin release from lumbar disc and facet joint tissue. Spine. Sep 15 1994;19(18):2068-70. [Medline].

Further Reading

Keywords

lumbar facet arthropathy, back pain, lower back pain, osteoarthritis, low back pain, facet joint, chronic back pain, lumbar spine, arthropathy, radiofrequency ablation, facet syndrome, facet arthropathy, lumbar facet, chronic low back pain, chronic lower back pain, facet joints, facet arthrosis, facet block, back osteoarthritis, nerve ablation, RF ablation, facet joint injection, facet joint injections, zygapophyseal joint arthropathy, zygapophysial joint arthropathy, facet joint syndrome, radiofrequency nerve ablation, RF nerve ablation

Contributor Information and Disclosures

Author

Carl H Shin, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Carl H Shin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and North American Spine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Medical Editor

J Michael Wieting, DO, MEd, Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Principles and Practices, Director of Sports Medicine, Associate Director of Physician Assistant Training Program, Department of Osteopathic Principles and Practice, Lincoln Memorial University-DeBusk College of Osteopathic Medicine
J Michael Wieting, DO, MEd is a member of the following medical societies: American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Sports Medicine, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and International Society of Physical and Rehabilitation Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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