Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain

Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. The onset of lumbar facet joint pain is usually insidious, with predisposing factors including spondylolisthesis, degenerative disc pathology, and old age. Despite previous reports of a "facet syndrome," the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article, the authors provide a comprehensive review of the anatomy, biomechanics, and function of the lumbar zygapophysial joints, along with a systematic analysis of the diagnosis and treatment of facet joint pain.

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Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000035 ◽

2019 ◽

Vol 44 (3) ◽

pp. 389-397 ◽

Cited By ~ 9

Author(s):

Zachary L McCormick ◽

Heejung Choi ◽

Rajiv Reddy ◽

Raafay H Syed ◽

Meghan Bhave ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Success Rate ◽

Joint Pain ◽

Rating Scale ◽

Facet Joint ◽

Prospective Trial ◽

Medial Branch ◽

Lumbar Facet Joint ◽

Facet Joint Pain ◽

Lumbar Facet

Background and objectivesNo previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.MethodsIn this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.ResultsForty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).ConclusionsWhen using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.Trial registration numberNCT02478437.

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Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up

Clinics ◽

10.6061/clinics/2014(08)05 ◽

2014 ◽

Vol 69 (8) ◽

pp. 529-534 ◽

Cited By ~ 8

Author(s):

ID Rocha ◽

AF Cristante ◽

RM Marcon ◽

RP Oliveira ◽

OB Letaif ◽

...

Keyword(s):

Joint Pain ◽

Facet Joint ◽

Medial Branch ◽

Lumbar Facet Joint ◽

Facet Joint Pain ◽

Lumbar Facet

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A Modified Posterolateral Approach for Radiofrequency Denervation of the Medial Branch of the Cervical Segmental Nerve in Cervical Facet Joint Pain Based on Anatomical Considerations

Pain Practice ◽

10.1111/papr.12499 ◽

2016 ◽

Vol 17 (5) ◽

pp. 596-603 ◽

Cited By ~ 1

Author(s):

Maarten van Eerd ◽

Arno Lataster ◽

Micha Sommer ◽

Jacob Patijn ◽

Maarten van Kleef

Keyword(s):

Joint Pain ◽

Facet Joint ◽

Posterolateral Approach ◽

Medial Branch ◽

Segmental Nerve ◽

Radiofrequency Denervation ◽

Facet Joint Pain ◽

Cervical Facet ◽

Cervical Facet Joint

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Pulsed radiofrequency therapy might be not inferior to thermal neurotomy in lumbar facet joint pain: a commentary

Rheumatology Reports ◽

10.4081/rr.2016.6167 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Haiko Sprott ◽

Norina Bergamin ◽

Armin Aeschbach

Keyword(s):

Pain Relief ◽

Joint Pain ◽

Facet Joint ◽

Medial Branch ◽

Pulsed Radiofrequency ◽

Lumbar Facet Joint ◽

Pulsed Radiofrequency Treatment ◽

Radiofrequency Therapy ◽

Facet Joint Pain ◽

Lumbar Facet

The effects of pulsed radiofrequency treatment in low back pain was evaluated in a routine clinical setting and compared with thermal neurotomy of nerve structures of the facet joint. The treatment of 19 patients with lumbar facet joint pain was prospectively evaluated. Follow-ups were recorded at 6 weeks and 6 months after intervention. Patients with ≥50% pain relief following controlled diagnostic local anesthetic block underwent medial branch neurotomy with thermal continuous radiofrequency (CRF, n=16) or pulsed radiofrequency (PRF, n=3). Experiences between the two radiofrequency modes in the treatment of facet joint pain were recorded. In the overall population, a facet joint pain reduction of 23% at 6 weeks, 20% at 6 months and an improvement in various clinical scores was achieved. CRF and PRF appeared to be similarly effective in the treatment of facet joint pain, providing pain relief for at least 6 months. These observations should encourage pain researcher to design meaningful studies to further address this concept.

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