Interventions for Lumbar Facet Joint Pain

Patient Guideline Summary

Publication Date: April 3, 2020

Objective

Objective

This patient summary means to discuss key recommendations from a multispecialty, international working group for interventions for lumbar facet joint pain.

Overview

Overview

  • Lumbar facet joint pain is one of many types of low back pain. It is usually the result of injury, either a single traumatic event or accumulated mechanical stress.
  • Lumbar facet joints connect vertebrae to each other on either side of the spinal column and are surrounded by pain, feeling, and motor (movement) nerves.
  • This patient summary focuses on methods of blocking pain from specific pain nerves near your spine.
  • Percutaneous (through the skin with needles, probes, or tiny incisions) techniques for back pain are relatively new and therefore controversial. Experience, refinements of technique, and consequently improvements in outcome are rapidly progressing.

Diagnosis

Diagnosis

  • In addition to a detailed history and physical examination, there are several imaging techniques that help localize the source of your pain.
    • Fluoroscopy
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT)
    • Single photon emission computed tomography (SPECT)
    • Scintigraphy (or gamma scan) that uses radioisotopes to localize bone abnormalities.
  • Identifying the precise nerve or nerves to block requires temporary blocking of a suspect nerve with either:
    • An injection of local anesthetic, often with added cortisone or
    • A tiny probe to freeze the nerve.

Treatment

Treatment

  • Once the target or targets are identified, a radiofrequency probe (like the freezing probe but heating rather than cooling) is inserted to block pain transmission. This is usually done using fluoroscopic guidance.
  • Precision placement is required to prevent damage to nearby nerves.
  • Repeat procedures are often done if relief is incomplete or pain recurs.
  • As with all medical and surgical treatments, there are occasional adverse side effects, all of which will be discussed in detail with you and your treatment team.

Abbreviations

  • CT: Computed Tomography
  • MRI: Magnetic Resonance Imaging
  • SPECT: Single Photon Emission Computed Tomography

Source Citation

Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional Anesthesia & Pain Medicine Published Online First: 03 April 2020. doi: 10.1136/rapm-2019-101243

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.