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INTRODUCTION

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  • The prevalence of persistent low back pain secondary to involvement of lumbosacral facet joints has been described in controlled studies as varying from 15% to 45% based on types of populations and setting studies. Lumbar facet joint interventions are used to diagnose as well as treat facet joint–related pain.

  • Prevalence of thoracic facet joint pain has been shown to be 34% to 48% in patients with chronic thoracic back pain.

  • Prevalence of cervical facet joint pain has been shown to be 36% to 67% in patients with chronic neck pain.

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INTRA-ARTICULAR FACET JOINT INJECTIONS AND MEDIAL BRANCH BLOCKS

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Indications

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Common indications for diagnostic facet joint interventions include the following:

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  • Lumbar spine

    • Traumatic or arthritic nonradicular low back pain.

    • Patients can experience pain radiating in to the buttock but rarely radiating beyond the level of the knee.

    • Pain on palpation is worse with extension of the lumbar spine and rotation or twisting of spine.

  • Thoracic spine

    • Traumatic or arthritic nonradicular upper back or posterior chest wall pain.

    • Typically the patient experiences pain on palpation and extension and rotation or twisting of thoracic spine.

  • Cervical spine

    • Traumatic or arthritic neck pain, suboccipital headache, persistent and disabling axial neck and/or upper thoracic pain or suspected cervicogenic headache

    • Typically pain and/or headache with neck movements in flexion, extension, and rotations

  • Duration of pain of at least 3 months

  • Average pain level of >5 on a scale of 0 to 10

  • Intermittent or continuous pain causing functional disability

  • Failure to respond to more conservative management including physical therapy modalities with exercises and nonsteroidal anti-inflammatory agents

  • Lack of evidence either for discogenic or sacroiliac joint pain

  • Lack of disk herniation or evidence of radiculitis

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CONTRAINDICATIONS

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Common contraindications for facet joint interventions include the following:

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  • Suspected or proven discogenic, sacroiliac joint or myofascial pain in case of lumbar facet interventions

  • Allergies to drugs being considered for the procedure

  • Inability of patient to understand consent, nature of the procedure, needle placement, or sedation

  • Localized or generalized infection

  • Anticoagulation therapy

  • Nonaspirin combination antiplatelet therapy

  • Pregnancy

  • Bleeding diathesis

  • Needle phobia

  • Psychogenic pain

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RELEVANT ANATOMY

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Lumbar Spine

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  • Facet joints (Figure 23-1)

    • Lumbar facet joints are formed by the articulation of the inferior articular process of the superior lumbar vertebra with the superior articular process of the inferior vertebra.

    • The lumbar joints exhibit features of typical synovial joints.

    • The articular facets are covered by articular cartilage, and the synovial membrane bridges the margins of the articular cartilage of the two facets in each joint.

    • Surrounding the synovial membrane is a joint capsule that attaches to the articular process, a short distance beyond the margins of the articular cartilage.

  • Ligaments

    • Ligaments connect spinous process, lamina, and bodies of the adjacent vertebrae.

    • Anterior and posterior longitudinal ligaments help stabilize ...

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