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Facet joint pain: Bogduk was among the first to recognize the role of facet joints as a source of spinal pain and contributed to the literature in anatomy, biomechanics, diagnosis, and therapeutics. He developed diagnostic and therapeutic techniques for facet joint pain, namely medial branch blocks and radiofrequency neurotomy.
For example, the facet joint between T1 and T2 is innervated by C8 and T1 medial branch nerves. Facet joint between L1 and L2; the T12 and L1 medial branch nerves. However, the L5 and S1 facet joint is innervated by the L4 medial branch nerve and the L5 dorsal ramus. In this case, there is no L5 medial branch to innervate the facet joint.
Facet syndrome is a syndrome in which the facet joints (synovial diarthroses) cause painful symptoms. [1] In conjunction with degenerative disc disease , a distinct but functionally related condition, facet arthropathy is believed to be one of the most common causes of lower back pain.
Facet joint injections are used to alleviate symptoms of Facet syndrome. [1] The procedure is an outpatient surgery, so that the patient can go home on the same day. It usually takes 10–20 minutes, but may take up to 30 minutes if the patient needs an IV for relaxation. [ 2 ]
Symptoms may include pain, stiffness, and restricted movements of the affected areas. The majority of people with DISH are not symptomatic, [3] and the findings are an incidental imaging abnormality. In some, the x-ray findings may correspond to symptoms of back stiffness with flexion/extension or with mild back pain. [2]
Nerve blocks are injections that target specific nerves to serve as both therapeutic and diagnostic purposes. They have been used for a variety of neuropathic conditions including facet joint pain. Nerve block injections specifically targeted at the superior cluneal nerves are limited. [ 5 ]
The clinician must be cautious when reconciling clinical symptoms and signs with postoperative computed tomography findings in patients operated on for lumbar spinal stenosis. [ 79 ] A study from Georgetown University reported on one-hundred patients who had undergone decompressive surgery for lumbar stenosis between 1980 and 1985.
The fourth criterion clinches the diagnosis: pain relieved by injection of local anesthetic into the correct facet joint. This diagnostic procedure can also be therapeutic; the injection of steroids or radiofrequency denervation of the medial branch can be added for refractory cases.