The provocative lumbar facet joint

Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain

Lumbar Zygapophysial Joint Radiofrequency Denervation: a Long-Term Clinical Outcome Study

Zygapophysial joint (z-joint) pain has long been suggested to be one of the sources of low back pain. Radiofrequency denervation of the medial branches of the dorsal rami to treat z-joint pain is an outpatient minimally invasive treatment option. There have been many short-term studies to determine the outcome of the procedure, but few long-term studies have been conducted. Our goal is to clarify whether radiofrequency denervation has any long-term clinical benefit. In this retrospective cohort study, a total of 42 patients (25 women and 17 men), with an average follow-up of 3.5 years, with clinical signs of zygapophysial joint involvement who had failed conservative treatment (pre-procedure symptom duration mean 6.03 years; range 5 months to 48 years) and had a favorable response to a diagnostic medial branch block or zygapophysial joint injection, were identified. The identified subjects underwent radiofrequency denervation at the Hospital for Special Surgery Physiatry Department from 1998 to 2006. Patient’s records were reviewed, and a questionnaire was provided, completed on phone call follow-up, or mailed by the patient. The success of this intervention in providing improvement in pain and function was analyzed using the Numerical Rating Scale (NRS)—11, North American Spine Society (NASS) four-point satisfaction index, and a modified Roland–Morris Disability Questionnaire (RMDQ). Fifty-two percent of patients reported a successful outcome with improved function at a minimum follow-up period of 2 years (mean 3.5 years, range 2–8.8 years). Patients in the failure group were more likely to be older and have moderate to severe neuroforaminal stenosis (77.8%) compared to patients in the success group (24.2%). Radiofrequency denervation in selected patients with chronic zygapophysial joint-mediated low back pain provides long-term reduction in pain and improved function with minimum morbidity