Facet joint syndrome: from diagnosis to interventional management

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Abstract

Low back pain (LBP) is the most common pain syndrome, and is an enormous burden and cost generator for society. Lumbar facet joints (FJ) constitute a common source of pain, accounting for 15–45% of LBP. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain. History and physical examination may suggest but not confirm facet joint syndrome. Although imaging (radiographs, MRI, CT, SPECT) for back pain syndrome is very commonly performed, there are no effective correlations between clinical symptoms and degenerative spinal changes. Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain. These patients may benefit from specific interventions to eliminate facet joint pain such as neurolysis, by radiofrequency or cryoablation. The purpose of this review is to describe the anatomy, epidemiology, clinical presentation, and radiologic findings of facet joint syndrome. Specific interventional facet joint management will also be described in detail.

Teaching points

• Lumbar facet joints constitute a common source of pain accounting of 15–45%.

• Facet arthrosis is the most frequent form of facet pathology.

• There are no effective correlations between clinical symptoms, physical examination and degenerative spinal changes.

• Diagnostic positive facet joint block can indicate facet joints as the source of pain.

• After selection processing, patients may benefit from facet joint neurolysis, notably by radiofrequency or cryoablation.

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Most cited references 93

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Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images.

Constantin Schizas, Nicolas Theumann, Alexandre Burn … (2010)

Retrospective radiologic study on a prospective patient cohort. To devise a qualitative grading of lumbar spinal stenosis (LSS), study its reliability and clinical relevance. Radiologic stenosis is assessed commonly by measuring dural sac cross-sectional area (DSCA). Great variation is observed though in surfaces recorded between symptomatic and asymptomatic individuals. We describe a 7-grade classification based on the morphology of the dural sac as observed on T2 axial magnetic resonance images based on the rootlet/cerebrospinal fluid ratio. Grades A and B show cerebrospinal fluid presence while grades C and D show none at all. The grading was applied to magnetic resonance images of 95 subjects divided in 3 groups as follows: 37 symptomatic LSS surgically treated patients; 31 symptomatic LSS conservatively treated patients (average follow-up, 2.5 and 3.1 years); and 27 low back pain (LBP) sufferers. DSCA was also digitally measured. We studied intra- and interobserver reliability, distribution of grades, relation between morphologic grading and DSCA, as well relation between grades, DSCA, and Oswestry Disability Index. Average intra- and interobserver agreement was substantial and moderate, respectively (k = 0.65 and 0.44), whereas they were substantial for physicians working in the study originating unit. Surgical patients had the smallest DSCA. A larger proportion of C and D grades was observed in the surgical group. Surface measurements resulted in overdiagnosis of stenosis in 35 patients and under diagnosis in 12. No relation could be found between stenosis grade or DSCA and baseline Oswestry Disability Index or surgical result. C and D grade patients were more likely to fail conservative treatment, whereas grades A and B were less likely to warrant surgery. The grading defines stenosis in different subjects than surface measurements alone. Since it mainly considers impingement of neural tissue it might be a more appropriate clinical and research tool as well as carrying a prognostic value.

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Costs of back pain in Germany.

Christina Wenig, Jörn Schmidt, Thomas Kohlmann … (2009)

With 12-month prevalence rates of more than 70%, back pain is currently one of the major health problems for German adults and entails major economic consequences. The aim of this study was to estimate back pain-related costs from a societal perspective and to determine the impact of sociodemographic variables on costs. Based on back pain-related survey data of a large German adult sample (9267 respondents, response rate 60%), costs were assessed using a prevalence-based bottom-up approach. Direct costs caused by utilisation of healthcare services, as well as indirect costs due to back pain-related production losses were considered. All prices are expressed in 2005 Euros. Average total back pain costs per patient were estimated to be 1,322 euro (95% CI [1173-1487]) per year. These costs are split between direct (46%) and indirect (54%) costs. Bivariate analysis showed considerable differences in total costs between the Von Korff back pain grades (GCPS Group I: Mean 414.4, 95% CI [333.2-506.3]; II: 783.6 [574.5-1044.4]; III: 3017.2 [2392.9-3708.6]; IV: 7115.7 [5418.5-9006.5]). Male gender, increasing age, single status, low education, unemployment, and increasing back pain grade had a significant positive impact on the cost magnitude in multivariate analysis. Despite several limitations, this study provides important information concerning the relevance of back pain as a health problem and its socioeconomic consequences. The information may be of value for decision-making and allocation of research fund resources.

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

Srinivasa N. Raja, Joshua Cohen (2007)

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.

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Author and article information

Contributors

Romain Perolat: rperolat@chu-grenoble.fr

Journal

Journal ID (nlm-ta): Insights Imaging

Journal ID (iso-abbrev): Insights Imaging

Title: Insights into Imaging

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 1869-4101

Publication date (Electronic): 8 August 2018

Publication date PMC-release: 8 August 2018

Publication date Collection: October 2018

Volume: 9

Issue: 5

Pages: 773-789

Affiliations

[1 ]ISNI 0000 0001 0792 4829, GRID grid.410529.b, Clinique Universitaire de Neuroradiologie, , Centre Hospitalier Universitaire A Michallon, ; Grenoble, France

[2 ]Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, A. Michallon, BP 217, 38043 Grenoble Cedex 9, France

[3 ]ISNI 0000 0001 0792 4829, GRID grid.410529.b, Service de Neurochirurgie, , Centre Hospitalier Universitaire A. Michallon, ; Grenoble, France

[4 ]GRID grid.488803.f, Centre d’évaluation et du traitement de la douleur, , Groupe hospitalier mutualiste, ; Grenoble, France

Article

Publisher ID: 638

DOI: 10.1007/s13244-018-0638-x

PMC ID: 6206372

PubMed ID: 30090998

SO-VID: 648f63ac-8b7d-42a5-8d27-8d48f9788e96

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 9 January 2018

Date revision received : 6 May 2018

Date accepted : 24 May 2018

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: low back pain,facet joint,block,neurolysis,radiofrequency,cryoablation

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: low back pain, facet joint, block, neurolysis, radiofrequency, cryoablation

Facet joint syndrome: from diagnosis to interventional management

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Abstract

Abstract

Teaching points

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Most cited references 93

Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images.

Costs of back pain in Germany.

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

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Contributors

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