Lumbar facet joint block

Studies report variable pain relief in response to diagnostic blocks of the medial branch nerves (MBN) which innervate facet joints indicating that these can be a source of low back pain. A variable number of low back pain (LBP) sufferers report clinically significant pain relief in response to medial branch blocks (MBBs) 1) 2) 3).

Facet blocks with anesthetic and cortisone, and even facet denervation procedures, have been recommended as treatment for patients with low back pain (LBP). The literature, however, fails to conclusively document the role of the facet in the production of LBP. Based on a review of the literature and the author's clinical studies, the following statements appear to be appropriate and defensible:

(1) The lumbar facet joints are very important biomechanically.

(2) The facet is not a common or clear source of significant pain.

(3) The facet joint syndrome is not a reliable clinical diagnosis.

(4) Injection of intraarticular saline into the facets in control cases is as effective as local anesthetic and steroids in relieving the patient's pain temporarily.

(5) Response to facet joint injection in patients with LBP does not correlate with or predict their clinical results after solid posterior lumbar fusion, and it should not be used preoperatively as a clinical criterion in selection of patients for fusion.

(6) More prospective, controlled and randomized clinical studies are recommended 4).

There is evidence that suggests that facet joint injections can be used to predict outcome after facet joint radiofrecuency. The predictive ability of facet joint injections does not appear to apply to lumbar fusion surgery. No evidence exists to support the effectiveness of facet injections in the treatment of patients with chronic low back pain. There is conflicting evidence suggesting that the use can be effective for the short-term relief of low-back pain. There are no data to suggest that with either steroids or anesthetics alone provide lasting benefit for patients suffering from chronic low-back pain 5).

see Lumbar facet joint denervation.

Nath S, Nath CA and Pettersson K. Percutaneous lumbar zygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine 2008; 33(12): 1291–1297; discussion 1298.
Juch JNS, Maas ET, Ostelo R, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the mint randomized clinical trials. JAMA 2017; 318(1): 68–81.
Cohen SP, Doshi TL, Constantinescu OC, et al. Effectiveness of lumbar facet joint blocks and predictive value before radiofrequency denervation: the Facet Treatment Study (FACTS), a randomized, controlled clinical trial. Anesthesiology 2018; 129(3): 517–535.
Jackson RP. The facet syndrome. Myth or reality? Clin Orthop Relat Res. 1992 Jun;(279):110-21. Review. PubMed PMID: 1534721.
Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC 3rd, Wang J, Walters BC, Hadley MN; American Association of Neurological Surgeons/Congress of Neurological Surgeons. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine. 2005 Jun;2(6):707-15. PubMed PMID: 16028741.
  • lumbar_facet_joint_block.txt
  • Last modified: 2020/03/02 22:00
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