Lumbar Facet Joint Injections and Medial Branch Blocks

Lumbar zygapophyseal joints have been considered a significant source of chronic low back. The zygapophyseal (facet) joints are true synovial joints, which connect adjancet vertebrae posteriorly. The medial branch of the posterior primary ramus is responsible for joint sensation. Symptoms of facet arthropathy include: hip and buttock pain,cramping lower extremity pain, usually not lower than the knee, low back stiffness, especially in the morning, pain commonly aggravated by prolonged sitting or stending. Signs of lumbar facet arthropathy are: paraspinal tenderness, worse over the affected joint, pain with movements that stresses the joints, i.e., hyperextension, lateral rotation and side bending, hip, buttock, or back pain on straight leg raising, absence of signs of nerve root irritation. Lumbar facet joint injection are performed for theurapeutic and diagnostic reason. Most studies have found that facet injection provide temporary pain relief. The current recommendations suggest the primary role of facet injection (intra-articular or medial branch block) to be diagnostic. These procedures may facilitate the diagnostic of facet syndrome and help predict if patient would benefit from more permanent measures, such as facet rhizotomy.