Skip to main content
Log in

The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

This article is the second article in a two-part review on lumbar facet joint pathology. In this review, we discuss the current concepts and controversies regarding the proper diagnosis and management of patients presenting with presumed facet-mediated lower back pain. All efforts were made to include the most relevant literature from the fields of radiology, orthopaedics, physiatry, and pain management. Our focus in this article is on presenting the evidence supporting or refuting the most commonly employed injection-based therapies for facet-mediated lower back pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jackson RP. The facet syndrome. Myth or reality? Clin Orthop Relat Res. 1992;279:110–21.

    PubMed  Google Scholar 

  2. Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007;37:69–80.

    Article  PubMed  Google Scholar 

  3. Helbig T, Lee CK. The lumbar facet syndrome. Spine. 1988;13:61–4.

    Article  CAS  PubMed  Google Scholar 

  4. Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine. 1984;9:746–50.

    Article  CAS  PubMed  Google Scholar 

  5. Nelemans PJ, de Bie RA, de Vet HC, Sturmans F. Injection therapy for subacute and chronic benign low back pain. Spine. 2001;26:501–15.

    Article  CAS  PubMed  Google Scholar 

  6. Eisenstein SM, Parry CR. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. J Bone Joint Surg Br. 1987;69:3–7.

    CAS  PubMed  Google Scholar 

  7. Carrera GF. Lumbar facet joint injection in low back pain and sciatica: preliminary results. Radiology. 1980;137:665–7.

    CAS  PubMed  Google Scholar 

  8. Carrera GF, Williams AL. Current concepts in evaluation of the lumbar facet joints. CRC Crit Rev Diagn Imag. 1984;21:85–104.

    CAS  Google Scholar 

  9. Fairbank JCT, Park WM, McCall IW, O’Brien JP. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine. 1981;6:598–605.

    Article  CAS  PubMed  Google Scholar 

  10. Jackson RP, Jacobs RR, Montesano PX. Facet joint injection in low-back pain: a prospective statistical study. Spine. 1988;13:966–71.

    Article  CAS  PubMed  Google Scholar 

  11. Revel ME, Listrat VM, Chevalier XJ, et al. Facet joint block for low back pain: identifying predictors of a good response. Arch Phys Med Rehabil. 1992;73:824–8.

    CAS  PubMed  Google Scholar 

  12. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Spine. 1994;19:1132–7.

    Article  CAS  PubMed  Google Scholar 

  13. Schwarzer AC, Wang S, O’Driscoll D, Harrington T, Bogduk N, Laurent T. The ability of computed tomography to identify a painful zygapophyseal joint in patients with chronic low back pain. Spine. 1995;20:907–12.

    Article  CAS  PubMed  Google Scholar 

  14. Pneumaticos SG, Chatziioannou SN, Hipp JA, Moore WH, Esses SI. Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology. 2006;238:693–8.

    Article  PubMed  Google Scholar 

  15. Dolan AL, Ryan PJ, Arden NK, Stratton R, Wedley JR, Hamann W, et al. The value of SPECT scans in identifying back pain likely to benefit from the facet joint injection. Br J Rheumatol. 1996;35:1269–73.

    Article  CAS  PubMed  Google Scholar 

  16. Holder LE, Machlin JL, Asdourian PL, Links JM, Sexton CC. Planar and high-resolution SPECT bone imaging in the diagnosis of facet syndrome. J Nucl Med. 1995;36:37–44.

    CAS  PubMed  Google Scholar 

  17. Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. The Spine Journal. 2008;8:56–64.

    Article  PubMed  Google Scholar 

  18. Bogduk N. A narrative review of intra-articular corticosteroid injections for low back pain. Pain Med. 2005;6(4):287–96.

    Article  PubMed  Google Scholar 

  19. Schwarzer AC, Derby R, Aprill CN, et al. Pain from the lumbar zygapophyseal joints: a test of two models. J Spinal Disord. 1994;7:331–6.

    Article  CAS  PubMed  Google Scholar 

  20. Schwarzer AC, Wang S, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophyseal joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis. 1995;54:100–6.

    Article  CAS  PubMed  Google Scholar 

  21. Manchikanti L, Pampati V, Fellows B, Baha AG. The inability of the clinical picture to characterize pain from facet joints. Pain Physician. 2000;3:158–66.

    CAS  PubMed  Google Scholar 

  22. Bogduk N, Wilson AS, Tynan W. The human lumbar dorsal rami. J Anat. 1982;134:383–97.

    CAS  PubMed  Google Scholar 

  23. Bogduk N. Innervation of the lumbar spine. Spine. 1983;8:286–93.

    Article  CAS  PubMed  Google Scholar 

  24. Bogduk N, Twomey LT. Clinical anatomy of the lumbar spine. 2nd ed. London: Churchill Livingstone; 1991.

    Google Scholar 

  25. Bogduk N, Long DM. Percutaneous lumbar medial branch neurotomy. A modification of facet denervation. Spine. 1980;5:193–200.

    Article  CAS  PubMed  Google Scholar 

  26. Derby R, Bogduk N, Schwarzer A. Precision percutaneous blocking procedures for localizing spinal pain. Part I: the posterior lumbar compartment. Pain Digest. 1993;3:89–100.

    Google Scholar 

  27. Schwarzer AC, Aprill CN, Derby R, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophyseal joints. Pain. 1994;58:195–200.

    Article  CAS  PubMed  Google Scholar 

  28. Manchikanti L, Pampati V, Fellows B, Bakhit CE. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999;2:59–64.

    CAS  PubMed  Google Scholar 

  29. Manchikanti L, Pampati V, Fellows B, Bakhit CE. The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents. Curr Rev Pain. 2000;4:337–44.

    CAS  PubMed  Google Scholar 

  30. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine. 1994;19:801–6.

    Article  CAS  PubMed  Google Scholar 

  31. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995;20:31–7.

    Article  CAS  PubMed  Google Scholar 

  32. Mooney V, Robertson J. The facet syndrome. Clin Orthop. 1976;115:149–56.

    PubMed  Google Scholar 

  33. Lynch MC, Taylor JF. Facet joint injection for low back pain. J Bone Joint Surg. 1986;68B:138–41.

    Google Scholar 

  34. Lilius G, Laasonen EM, Myllynen P, Harilainen A, Salo L. Lumbar facet joint syndrome. Significance of non-organic signs. A randomized placebo-controlled clinical study. Rev Chir Orthop Reparatrice Appar Mot. 1989;75:493–500.

    CAS  PubMed  Google Scholar 

  35. Lilius G, Laasonen EM, Myllynen P, Harilainen A, Gronlund G. Lumbar facet joint syndrome: a randomized clinical trial. J Bone Joint Surg. 1989;71(4):681–4.

    CAS  Google Scholar 

  36. Lilius G, Harilainen A, Laasonen EM, Myllynen P. Chronic unilateral back pain: predictors of outcome of facet joint injections. Spine. 1990;15:780–2.

    CAS  PubMed  Google Scholar 

  37. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, et al. A controlled trial of corticosteroid injections into facets joints for chronic low back pain. N Engl J Med. 1991;325(14):1002–7.

    Article  CAS  PubMed  Google Scholar 

  38. Manchikanti L, Staats PS, Singh V, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2003;6:3–81.

    PubMed  Google Scholar 

  39. Slipman CW, Bhat AL, Gilchrist RV, et al. A critical review of the evidence for the use of zygapophyseal injections and radiofrequency denervation in the treatment of low back pain. Spine J. 2003;3:310–6.

    Article  PubMed  Google Scholar 

  40. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, et al. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2007;10(3):425–40.

    PubMed  Google Scholar 

  41. Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Lumbar facet joint nerve blocks in managing chronic facet joint pain: one-year follow-up of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 2008;11(2):121–32.

    PubMed  Google Scholar 

  42. Giles LG, Hasrvey AR. Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J Rheumatol. 1987;26:362–4.

    Article  CAS  PubMed  Google Scholar 

  43. Giles LGF, Taylor JR. Innervation of the lumbar zygapophyseal joint folds. Acta Orthop Scand. 1987;58:43–6.

    Article  CAS  PubMed  Google Scholar 

  44. Ashton IK, Ashton BA, Gibson SJ, Polak JM, Jaffray DC, Eisenstein SMJ. Morphological basis for low back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in the ligamentum flavum. J Orthop Res. 1992;10:72–8.

    Article  CAS  PubMed  Google Scholar 

  45. Shealy CN. Facets in back and sciatic pain. Minn Med. 1974;57:199–203.

    CAS  PubMed  Google Scholar 

  46. Shealy CN. The role of the spinal facets in back and sciatic pain. Headache. 1974;14:101–4.

    Article  CAS  PubMed  Google Scholar 

  47. Shealy CN. Percutaneous radiofrequency denervation of spinal facets. J Neurosurg. 1975;43:448–51.

    Article  CAS  PubMed  Google Scholar 

  48. Shealy CN. Facet denervation in the management of back sciatic pain. Clin Orthop. 1976;115:157–64.

    PubMed  Google Scholar 

  49. Bogduk N, Long DM. The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low back pain. J Neurosurg. 1979;51:172–7.

    Article  CAS  PubMed  Google Scholar 

  50. Bogduk N, Long DM. Percutaneous lumbar medial branch neurotomy. A modification of facet denervation. Spine. 1980;5:193–200.

    Article  CAS  PubMed  Google Scholar 

  51. Fs L, Goldring S. The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg. 1968;29:42–7.

    Article  Google Scholar 

  52. Frohling MA, Schole W, Wolburg-Bucholz K. Nonselective nerve fiber damage in peripheral nerves after experimental thermocoagulation. Acta Neurochir. 1998;140:1297–302.

    Article  CAS  Google Scholar 

  53. International Spine Interventional Society. An algorithm for the investigation of low back pain. In: Bogduk N, editor. Practice guidelines for spinal diagnostic and treatment procedures. San Francisco, CA: International Spinal Intervention Society; 2004. p. 87–94.

    Google Scholar 

  54. Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy. Pain Med. 2004;5:289–98.

    Article  PubMed  Google Scholar 

  55. Vad VB, Cano WG, Basrai D, Lutz GE, Bhat AL. Role of radiofrequency denervation in lumbar zygapophyseal joint synovitis in baseball pitchers: a clinical experience. Pain Physician. 2003;6(3):307–12.

    PubMed  Google Scholar 

  56. Mogalles AA, Dreval ON, Akatov OV, Kuznetsov AV, Rynkov IP, Plotnikov VM, et al. [Percutaneous laser denervation of the zygapophyseal joints in the pain facet syndrome] – Article in Russian. Zh Vopr Neirokhir IM N N Burdenko 2004 Jan–Mar; (1): 20–25.

  57. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine. 1999;24:1937–42.

    Article  PubMed  Google Scholar 

  58. Gallagher J, Petriccione Di Vadi PL, Wedley JR, Hamman W, Ryan P, et al. Radiofrequency facet joint denervation in the treatment of low back pain: a prospective controlled double-blind study to assess its efficacy. Pain Clin. 1994;7:193–8.

    Google Scholar 

  59. Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled trial to assess efficacy. Spine. 2001;26:1411–6.

    Article  CAS  PubMed  Google Scholar 

  60. van Wijk RM, Geurts JW, Wynne HKJ, Hammink E, Buskens E, Lousberg R, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain. 2005;21:335–44.

    Article  PubMed  Google Scholar 

  61. Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophyseal (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine. 2008;33(12):1291–7.

    Article  PubMed  Google Scholar 

  62. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophyseal joint pain. Spine. 2000;25:1270–7.

    Article  CAS  PubMed  Google Scholar 

  63. Gofeld M, Jitendra J, Faclier G. Radiofrequency denervation of the lumbar zygapophyseal joints: 10-year prospective clinical audit. Pain Physician. 2007;10:291–9.

    PubMed  Google Scholar 

  64. Cohen SP, Stojanovic MP, Crooks M, Kim P, Schmidt RK, Shields CH, et al. Lumbar zygapophyseal (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis. Spine J. 2008;8(3):498–504. Epub 2007 Jun 18.

    Article  PubMed  Google Scholar 

  65. Morrisette DC, Brown D, Saladin ME. Temperature changes in lumbar peri-articular tissue with continuous ultrasound. J Orthop Sports Phys Ther. 2004;34(12):754–60.

    PubMed  Google Scholar 

  66. Stieber J, Quirno M, Cunningham M, Errico TJ, Bendo JA. The reliability of computed tomography and magnetic resonance imaging grading of lumbar facet arthropathy in total disc replacement patients. Spine. 2009;34(23):E833–40.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Todd R. Lefkowitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varlotta, G.P., Lefkowitz, T.R., Schweitzer, M. et al. The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management. Skeletal Radiol 40, 149–157 (2011). https://doi.org/10.1007/s00256-010-0984-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-010-0984-3

Keywords

Navigation