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Facet joint injections came into use from 1963, when Hirsch injected a hypertonic solution of saline into facet joints. [3] He found that this solution relieved lower back pain in the sacroiliac and gluteal regions of the spine. In 1979 fluoroscopy was used for guidance of the needle into the facet joints with steroids and local anesthetics. [3]
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. [2] [3]
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.
Systemic oral steroids have not been shown to be useful in low back pain. [1] [19] Facet joint injections and steroid injections into the discs have not been found to be effective in those with persistent, non-radiating pain; however, they may be considered for those with persistent sciatic pain. [104]
Bertolotti's syndrome is characterized by sacralization of the lowest lumbar vertebral body and lumbarization of the uppermost sacral segment. It involves a total or partial unilateral or bilateral fusion of the transverse process of the lowest lumbar vertebra to the sacrum, leading to the formation of a transitional 5th lumbar vertebra.
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]
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A 2007 Cochrane review of prolotherapy in adults with chronic low-back pain found unclear evidence of effect. [5] A 2009 review concluded the same for subacute low back pain. [6] A 2015 review found consistent evidence that it does not help in low back pain. [4] There was tentative evidence of benefit when used with other low back pain treatments.