Facet joint injections for management of low back pain: a clinically focused review

Abstract

Lumbar facet joints have been implicated in chronic low back pain in up to 45% of patients with low back pain (LBP). Facet joint pain diagnosis and management are always challenging for pain physicians. Facet joint pain is not diagnosed by specific demographic features, pain characteristics, or physical findings, even though electrodiagnostic studies and imaging modalities are available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Treatment of chronic LBP arising due to facet joint includes intraarticular injections, medial branch blocks, and radiofrequency neurotomy. However, the evidence of their clinical efficacy is continuously under scrutiny. Pain physicians must have a detailed understanding of the spinal anatomy in order to perform safe and effective interventional procedures. This review outlines the important aspects of spinal anatomy as they relate to interventional pain management related to facet joint injections. Additionally, we provide a comprehensive review of the procedure and clinical evidence.

Therapeutische Injektion und Manuelle Medizin beim tiefen Rückenschmerz

“…:23 revidiert: 150 von 520 [ 10 , 60 ] inkludiert: 25, RCT: 15 revidiert: 117 von 428 BSV und/oder Radikulopathie LA + GK: gut LZ & KZ nur LA: moderat LA + GK: gut LZ & KZ nur LA: moderat LA + GK: gut LZ & KZ nur LA: moderat Diskogener oder axialer TRS LA + GK: gut LA + GK: gut nur LA: schlech t LA + GK: schlecht nur LA: schlecht Spinalstenose LA + GK: moderat LA + GK: moderat LA + GK: moderat „Post-surgery“-Syndrom LA + GK: moderat ? LA + GK: schlecht nur LA: schlecht Therapeutische lumbale Facettengelenksinterventionen (FGI) Technik: Intraartikuläre FGI „Medial-branch“-Block Radiofrequenzablation Reviews gesamt: (nur bildgestützt, Ausnahme LOR) Schlecht [ 15 , 26 , 62 , 96 , 108 ] LZ: gut [ 26 ], LZ: moderat [ 9 , 15 , 23 , 62 , 96 , 108 ] KZ: gut [ 62 , 108 ], moderat [ 9 ] Gut [ 26 ], moderat [ 15 , 62 , 96 ], ( gepulst limitiert , 1 non-RCT) ASIPP-Review, 1966–2011 [ 26 ] inkludiert: 25, RCT: 11, non-RCT 14 revidiert: 122 von 335 Positiv : 5 non-RCT ...…”

“…1 a und b führt differenzialdiagnostisch nicht sicher weiter, da vereinbar mit (Tab. 2 ): lokalem Schmerz bei Facettensyndrom (FGS) L5/S1 (oder L4/5) [ 73 , 108 ] bei Spondylarthrose, viszerogen übertragenem Schmerz („referred pain“): z. B. aus Dickdarm (Th11), bei bekannten Unterbauchschmerzen [ 103 ], pseudoradikulärem Schmerz als Ausdruck artikulärer Störung mit reflektorischer Muskelirritation (manifestiert als Triggerpunkte) von M. iliocostalis/longissimus [ 28 ], M. quadratus lumborum oder M. gluteus medius [ 24 ], und/oder radikulärem Schmerz entsprechend Dermatom L5/S1 rechts, bei Minderung des Intervertebralraumes (IVR) L5/S1.…”

Medical ozone therapy in facet joint syndrome: an overview of sonoanatomy, ultrasound-guided injection techniques and potential mechanism of action

“…Ultrasound-guided facet injections are performed by a specialist experienced in the musculoskeletal ultrasound using a low-frequency curvilinear probe (3)(4)(5)(6)(7)(8).…”

“…6 Diagnostic blocks commonly include low-volume intraarticular injections of local anesthetic (lidocaine and/or bupivacaine), with or without steroids. 7 A diagnostic positive facet joint block allows to identify patients may benefit from specific minimally invasive modalities of intervention 7 such as intra-articular steroid injections and medial branch neurolysis, by radiofrequency denervation or cryoablation. 8,9 These interventions are used after failure of conservative multimodal management, including drug therapy (acetaminophen, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, antidepressants), physiotherapy and acupuncture.…”

“…8,9 These interventions are used after failure of conservative multimodal management, including drug therapy (acetaminophen, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, antidepressants), physiotherapy and acupuncture. 7 Oxygen-ozone (O 2 -O 3 ) has been shown to have positive results in acute and chronic spinal-degeneration diseases and it could be a safe and efficacious alternative to failed traditional facet joint conservative treatments. 10,11 The primary purpose of this review article is to describe a specific interventional facet joint management with ultrasound-guided O 2 -O 3 therapy, providing an anatomy and sonoanatomy overview of lumbar facet joints.…”