Facet Injections and Radiofrequency Denervation

Abstract

Each spinal segment from C2 caudal possesses three joints: anteriorly, the disc and associated uncovertebral joint and posteriorly, the paired facet joints. For almost a century, the lumbar facet (zygapophyseal) joint has been considered a significant source of low back pain. Ghormley was the first to describe the facet syndrome, which he defined as a lumbosacral pain with or without radiculopathy, occurring most often after a sudden twisting or rotary strain of the lumbosacral region. Hirsch et al. injected hypertonic saline in the region of the lumbar facet joints, which resulted in pain in the sacroiliac and gluteal regions with radiation to the greater trochanter. Mooney and Robertson performed saline intra-articular facet injections that resulted in a similar pain referral pattern; however, they noted that the pain was relieved by intra-articular local anesthetic injection. Similar findings were produced in the cervical spine, with cervical facet injection of hypertonic saline by Pawl, resulting in neck pain and headache.