Abstract
Chronic low back and neck pain remain prevalent medical concerns, with much debate regarding the effective evaluation and treatment. Facet disease has been implicated as a source of axial nonradiating low back pain. We discuss patient evaluation, the role of imaging, current and emerging image-guided therapies for facet-related pain, and the increasing importance of outcome-related research in this arena.
Highlights
Diagnostic image-guided medial branch nerve blocks have the most convincing evidence for isolating the facet joint as a pain generator, despite ongoing debate regarding the need for staged serial blocks or placebo-controlled blocks before proceeding to interventional therapy.[39]
With increasing attention on outcomes and the cost-effectiveness of therapy, discussion continues regarding how to best identify patients who will benefit and whether the cost and time required for multiple and/or placebo-controlled diagnostic blocks translates into better patient selection or may exclude patients from receiving beneficial therapy.[59]
Neuroradiologists need to be aware of the role of facet joints as a possible independent or contributory pain generator in the evaluation of patients with chronic low back pain
Summary
Diagnostic image-guided medial branch nerve blocks have the most convincing evidence (level I) for isolating the facet joint as a pain generator, despite ongoing debate regarding the need for staged serial blocks or placebo-controlled blocks before proceeding to interventional therapy.[39] To perform the diagnostic block, the patient should first be examined to establish a baseline pain level. Image-Guided Therapy Facet joint interventions may be considered in patients with Ͼ3 months of persistent nonradicular axial spine pain or cervicogenic headache, resulting in functional disability and not responding to conservative medical management or physical therapy.[39]
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