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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 joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful muscle spasm.
Some evidence supports the use of facet joint injections, transforminal epidural injections and sacroiliac injections as diagnostic tests. [5] Most other physical tests, such as evaluating for scoliosis, muscle weakness or wasting, and impaired reflexes, are of little use. [5]
Opiates are usually prescribed for pain for management of this condition. Conversely, facet joint injections are not indicated for the treatment of syringomyelia. [30] Radiation is rare, but may be used if a tumor is involved. In these cases, it can halt the extension of a cavity and may help to alleviate pain. [31]
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.
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.
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.
Degeneration or damage to the facet joints can often lead to facet joint syndrome, which can be both diagnosed and treated by image-guided injection of anesthetics. [39] Facet joint block is a minimally invasive procedure in which a physician uses fluoroscopy or CT imaging to guide the placement of an injection of medication into a facet joint ...