Lumbar Facet Arthropathy 

  • Author: Carl H Shin, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Jan 18, 2012
 

Background

Low back pain (LBP) remains a common musculoskeletal complaint, with a reported lifetime incidence of 60-90%. Various structures have been incriminated as possible sources of chronic LBP, including the posterior longitudinal ligament, dorsal root ganglia, dura, annular fibers, muscles of the lumbar spine, and facet joints.

In 1911, Goldwaith first implicated the facet joints as a source of LBP. In 1933, Ghormley described the facet syndrome, and in 1941, Badgley endorsed the idea of the facets as the cause of LBP, based on pathomorphologic studies of the joint.[1, 2] Rees in 1972 and Shealy in 1974 accepted the notion and developed techniques in which the joint allegedly could be denervated to stop pain stemming from the facet joints.[3, 4]

In 1963, Hirsch and colleagues injected normal saline into facet joints, demonstrating that facet joints can produce LBP.[5] Systematic studies began in 1976, when Mooney and Robertson used fluoroscopy to confirm this location of intra-articular lumbar facet joint injections of normal saline in asymptomatic volunteers.[6] (Three years later, McCall and colleagues did the same.[7] ) These injections of normal saline caused back and lower extremity pain. In addition, Mooney and Roberts documented relief of low back and lower extremity pain in these patients after injection of local anesthetic into the provoked facet joints. A 1989 study by Marks demonstrated similar findings in patients with chronic LBP.[8]

In 1991, Kuslich and colleagues probed facet joint capsules in patients undergoing lumbar decompression surgeries and found that pain could be induced.[9] Many investigators developed techniques to diagnose facet joint pain using intra-articular joint blocks and medial branch nerve blocks, as well as ways to treat such pain with intra-articular steroids, surgical ablation, or radiofrequency (RF) denervation. Controversy continues regarding the true prevalence, most accurate diagnostic methods, and most efficacious treatment of symptomatic lumbar facet joints.[10]

Related eMedicine topics:

Back Pain, Mechanical

Cervical Facet Syndrome

Lumbosacral Facet Syndrome

Mechanical Low Back Pain

Next

Pathophysiology

Bones of the spine articulate anteriorly by intervertebral disks and posteriorly by paired joints. The latter, formally known as zygapophyseal joints (but commonly termed facet joints), are true synovial joints, with a joint space, hyaline cartilage surfaces, a synovial membrane, and a fibrous capsule. Two medial branches of the dorsal rami innervate the facet joints. Medial branches of the lumbar dorsal rami issue from their respective intervertebral foramina, cross the superior border of the transverse process, and then run medially around the base of the facet joint before innervating the joints.

In studies, autonomic nerves and nociceptive, substance P – immunoreactive nerve fibers and autonomic nerves have been identified in the lumbar facet joint capsule and synovial folds. Douglas and colleagues identified substance P – immunoreactive nerve fibers in erosion channels that extended through the subchondral bone and calcified cartilage into the articular cartilage. Giles and Harvey identified them in the inferior recess capsule and synovial folds, whereas Ashton and coauthors found them running freely in the facet capsule stroma.[11, 12] Grönblad and colleagues demonstrated sparsely distributed substance P – immunoreactive nerve fibers in facet joint plical tissue.[13]

The presence of nociceptive nerve fibers in the various tissue structures of facet joints, as well as the existence of autonomic nerves there, suggests that these structures may cause pain under increased or abnormal loads. Substance P is a well-known inflammatory mediator that may sensitize nociceptors to them and other mediators, resulting in chronic pain.

Like other joints, the facet joints consist of bone, cartilage, synovial tissue, and menisci that are rudimentary invaginations of the joint capsule. In the synovial fluid of patients with rheumatoid arthritis, osteoarthritis, or traumatic joint disease, increased levels of prostaglandins have been measured and are implicated as an important cause of pain. Prostaglandin, a known inflammatory mediator, also is released from facet joints.

Biomechanically, facet joints assume a prominent role in resisting stress, and their importance is well established. A cadaveric study by Adams and Hutton demonstrated that the facet joints resist most of the intervertebral shear force and share in resisting the intervertebral compressive force, albeit only in lordotic postures.[14] In the rotation of the spine, the facet capsular ligaments are the spinal ligaments that undergo by far the most strain. They protect the intervertebral disks by preventing excessive movement.[15]

Previous
Next

Epidemiology

Frequency

United States

The prevalence of facet joint pain in the general population or in persons with acute back pain has not been investigated. The reported rate of facet joint pain for patients with chronic low back pain (LBP) ranges from 4-75%. The reported prevalence seems to be a function of the size of the sample studied and the conviction of the authors.

Three studies report the prevalence of lumbar facet joint pain among chronic LBP patients based on 100% relief of pain using less than 2 mL of intra-articular diagnostic injection. In 1988, Jackson and colleagues reported that 7.7% of 454 patients with chronic LBP had 100% relief with diagnostic injection.[16] In 1991, Carette and coauthors reported that 11 (5.8%) of 190 patients experienced complete relief of symptoms with a single lidocaine injection.[17] In 1994, Schwarzer and colleagues reported that 7 (4%) of 176 patients reported 100% relief.[18, 19] This last study was the most stringent of the 3 because the authors performed a second confirmatory block with bupivacaine, documenting longer relief of pain commensurate with the longer half-life of the local anesthetic.

When less stringent criteria are used, higher prevalences of lumbar facet joint pain are reported. In 1988, Moran and colleagues reported relief in 9 (16.7%) of 45 patients using 1.5 mL of bupivacaine.[20] Pain provocation followed by pain relief with local anesthetic was used as the diagnostic criterion. In 1992, Schwarzer and co-investigators reported relief in 9 (9.8%) of 92 patients, using a 50% reduction of pain as the criterion and employing double-block screening with lidocaine and confirmatory bupivacaine block.[21] In a separate investigation, Schwarzer and colleagues reported a prevalence of 26 (15%) of 176 patients, using the same diagnostic criterion.[18, 19]

In another study, Schwarzer and coauthors reported that 23 (40.3%) of 57 patients obtained pain relief of 50% or more pain with bupivacaine but experienced no relief with saline control injection.[22] A 2004 study by Manchikanti and colleagues reported a 27% prevalence rate of lumbar facet pain, using controlled, comparative local anesthetic blocks of the dorsal medial nerves.[23]

Higher prevalence rates are reported when control blocks are not used. In 1984, Raymond and Dumas—using a strict intracapsular technique but no control block—reported a 16% prevalence rate.[24] In 1992, Revel and coauthors reported that 22 (55%) of 40 subjects had pain relief of 75% or more and that 17 (42.5%) of 40 patients had greater than 90% relief of their pain with a single intra-articular lidocaine injection.[25]

As seen from these data, reports of prevalence are a function of the investigators' choice of selection criteria. Studies requiring the most stringent criteria (100% relief of symptoms after a diagnostic block) report a 4-7.7% prevalence rate of facet joint pain among chronic LBP patients. Investigations using double blocks and requiring 50% relief report prevalence rates of about 10-15%. Numerous other studies using a single diagnostic block report prevalence rates of 16-75%.

International

See Frequency/United States.

Mortality/Morbidity

No studies specifically address the mortality and morbidity of chronic back pain from facet joint – mediated pain. The mortality and morbidity of chronic low back pain, however, have been extensively addressed.

Race

No studies have specifically addressed the correlation between the prevalence of facet-mediated chronic low back pain and race.

Sex

No studies have specifically addressed the male-to-female prevalence ratio of chronic, facet-mediated low back pain.

Age

A higher prevalence among the older population would be expected if the etiology of facet joint–mediated back pain arose from degenerative changes of the joint, similar to the way it does in other osteoarthritic joint damage. One small study by Revel and colleagues and a larger investigation by Jackson and coauthors noted that older patients responded more commonly to diagnostic injections.[16, 25] The 1995 study by Schwarzer and colleagues involving 57 patients reported higher positive response rates in older patients (40%), even with the use of saline control injections.[22] They noted that the average age of patients was 59 years, which was higher than the average age in studies reporting much lower prevalence rates.

A 2008 report by Manchikanti et al looked at the rate of facet joint–related chronic low back pain in 424 patients, separated into 6 age groups.[26] According to their retrospective analysis, the prevalence ranged from 18% (in individuals aged 31-40 years) to 44% (in persons aged 51-60 years).

Previous
Proceed to Clinical Presentation
 
 
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.

Specialty Editor Board

J Michael Wieting, DO, MEd  Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Principles and Practices, Director of Program Development, Director of Sports Medicine, Associate Director of Physician Assistant 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 Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Osteopathic Academy 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  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 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.

Kelly L Allen, MD  Medical Director, Medevals

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.

Additional Contributors

The editors wish to gratefully acknowledge Mark I Ellen, MD, Assistant Professor, Department of Orthopedics and Rehabilitation Medicine, The Emory Sports Medicine Center, for his previous participation in this article.

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. Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician. Nov-Dec 2011;14(6):545-57. [Medline].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

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

  21. 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.

  22. 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].

  23. 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].

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

  25. 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].

  26. 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].

  27. Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, et al. The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management. Skeletal Radiol. Feb 2011;40(2):149-57. [Medline].

  28. 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].

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

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

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

  32. Maus T. Imaging the back pain patient. Phys Med Rehabil Clin N Am. Nov 2010;21(4):725-66. [Medline].

  33. 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].

  34. 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].

  35. 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].

  36. 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].

  37. 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].

  38. 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].

  39. 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].

  40. 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.

  41. 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].

  42. 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].

  43. 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].

  44. 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].

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

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

  47. 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].

  48. 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].

  49. 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].

  50. 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].

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

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

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

  54. 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].

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

  56. 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].

  57. 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].

  58. 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].

  59. 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].

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

  61. 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].

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

  63. 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].

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

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

  66. 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].

  67. 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].

  68. 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].

  69. 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].

  70. 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].

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

 
Previous
Next
 
Anteroposterior view of right L4-5 facet intra-articular injection with contrast.
Lateral view of right L4-5 facet intra-articular injection with contrast.
Oblique view of right L4-5 facet intra-articular injection with contrast.
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 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 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 needle position (tip of the needle is at the neck of the right L5 transverse process, just below L4-5 facet joint).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.