The document discusses facet joint pain, which originates from structures in the lumbar facet joints. It can be a source of low back pain, especially in older individuals. Precise diagnosis is difficult without diagnostic blocks or imaging. Treatment options include conservative treatments, steroid injections, and radiofrequency denervation.

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