Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain

Steven P. Cohen, Srinivasa N. Raja

Research output: Contribution to journalReview articlepeer-review

272 Scopus citations

Abstract

Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. The onset of lumbar facet joint pain is usually insidious, with predisposing factors including spondylolisthesis, degenerative disc pathology, and old age. Despite previous reports of a "facet syndrome," the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. The most accepted method for diagnosing pain arising from the lumbar facet joints is with low-volume intraarticular or medial branch blocks, both of which are associated with high false-positive rates. Standard treatment modalities for lumbar zygapophysial joint pain include intraarticular steroid injections and radiofrequency denervation of the medial branches innervating the joints, but the evidence supporting both of these is conflicting. In this article, the authors provide a comprehensive review of the anatomy, biomechanics, and function of the lumbar zygapophysial joints, along with a systematic analysis of the diagnosis and treatment of facet joint pain.

Original languageEnglish (US)
Pages (from-to)591-614
Number of pages24
JournalAnesthesiology
Volume106
Issue number3
DOIs
StatePublished - Mar 2007

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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