Facet Joint Pain

1. Ade Wijaya, MD
November 2017
FACET JOINT PAIN

2. Outline:
 Introduction
 Anatomy
 Epidemiology
 Diagnosis
 Treatment
 Summary

3. Introduction
 pain originating from any structure integral to both
the function and configuration of the lumbar facet
joints, including the fibrous capsule, synovial
membrane, hyaline cartilage surfaces, and bony
articulations.
 Rich on nociceptors  potential pain generator
 Lumbar facet joint pain remains a misunderstood,
misdiagnosed, and improperly treated medical
condition
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 106(3), 591-614.
Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI: Lumbar facet pain: Biomechanics, neuroanatomy and neurophysiology. J Biomechanics 1996; 29:1117–
29Cavanaugh, JM Ozaktay, AC Yamashita, HT King, AI
Stillwell DL: The nerve supply of the vertebral column and its associated structures in the monkey. Anat Rec 1956; 125:136–69Stillwell, DL

4. Introduction
 First noted by Goldthwite in 1911
 Ghormley 1933  Facet Syndrome
 Shealy 1970-s; RF to treat facet joint pain
Goldthwaite JE: The lumbosacral articulation: An explanation of many cases of lumbago, sciatica, and paraplegia. Boston Med Surg J 1911; 164:365–72Goldthwaite, JE
Ghormley RK: Low back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA 1933; 101:1773–7Ghormley, RK
Shealy CN: Percutaneous radiofrequency denervation of spinal facets: Treatment for chronic back pain and sciatica. J Neurosurg 1975; 43:448–51
Shealy CN: Facet denervation in the management of back and sciatic pain. Clin Orthop 1976; 115:157–64

5. Anatomy
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment
of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of
the American Society of Anesthesiologists, 106(3), 591-614.

7. Epidemiology
 Elder age
 10-15 % of all LBP
 L5–S1, L4–L5, and L3–L4 facet joints
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 106(3), 591-614.

8. Pain Refferal Pattern
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 106(3), 591-614.

9. Diagnosis
 History and physical exam can’t reliably predict

10. Diagnostic Blocks
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 106(3), 591-614.

11. Treatment
 Conservative Treatment and Pharmacotherapy
 Intraarticular Steroid Injections
 Radiofrequency Denervation
 Surgery (only for traumatic dislocation)
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 106(3), 591-614.

12. Summary
 Source of LBP
 Aging
 Rotational forces
 L3-L4, L4-L5, L5-S1
 Diagnostic block & CT/MRI
 Conservative treatment, intraarticular injection, or
radiofrequency denervation