Low Back Pain due to Lumbar Facet Joint Arthropathy and its Management

Ashok Jadon

doi:10.4172/2327-5146.1000252

Abstract

Low back pain is a very common problem which brings a patient to orthopedic clinic or pain clinic. It is estimated that it affects about 60–80% of general population in the whole life and facet joints are responsible for back pain in 15%–45% of such cases. Multimodal approach including analgesics and back strengthening exercise are primary treatments. However, sustained relief can be achieved by radiofrequency ablation after proper diagnosis.

Highlights

The vertebral facet joints are synovial joints with hyaline cartilage a synovial membrane, and a joint capsule [1]
As any typical synovial joint, facet joints have two articular surfaces formed by inferior articular process (IAP) of the upper vertebra and the superior articular process (SAP) of the lower vertebra [2]
Facet joints are potential source of pain in low back pain (LBP) and its prevalence increases with age [3,4]

Summary

Introduction

The vertebral facet joints (zygapophyseal joints) are synovial joints with hyaline cartilage a synovial membrane, and a joint capsule [1]. Facet joint as a source of pain can be confirmed by injection of local anaesthetic either into facet joint (intra articular injection) or by medial branch blocks. - debate exists regarding the need for serial block (synonyms: dual blocks, sequential block) or placebo-controlled blocks before proceeding to interventional therapy like radiofrequency ablation, diagnostic image-guided medial branch nerve blocks have level I evidence for identification of painful facet joint. Interventional management of facet arthropathy is done through injection of local anaesthetic (with or without steroid) either within the joint (intra-articular injection) or on to the medial branches [26,31,35,36,37,38,39,40]. It is recommended that the RFA needle should be positioned along the lateral neck of the superior articular process and not in the groove between superior articular and transverse processes

RFA Procedure

A Point to Ponder

Findings

Conclusion