Lumbar facet joint injection: indication,

technique, clinical correlation, and preliminary

results.
RFS Journal Primer

Quick Summary
BOTTOM LINE

Lumbar facet block is an excellent means of determining if a patients pain is due to facet arthropathy.
Not only does it aid in diagnosis but when injected with anesthetic pain relieve can be achieved
immediately. Patients who had not undergone previous surgery had a better initial response and
longer improvement than those who had undergone laminectomy or spinal fusion.

MAJOR POINTS

Fluoroscopic controlled intraarticular facet arthrography and block is a reliable technique for
diagnosing and treating low back pain due to lumbar facet syndrome.

Facet joint distention by contrast material reproduces the patients pain, while instillation of the
local anesthetic relieves it.

CRITICISM
The biggest problem is the initial clinical determination of those patients who may have facet
syndrome and the decision as to which level(s) to inject.

Study design
A Prospective analysis was completed

44 patients with acute or chronic back pain underwent facet block. 41 had no
previous surgery. 13 had a previous laminectomy and or fusion.

INCLUSION CRITERIA

Choice of injection level was based on clinical evidence, especially focal

tenderness.

If no focal tenderness was elicited L4-5 or L5-S1 was injected bilaterally.

EXCLUSION CRITERIA

If there was no focal tenderness but osteoarthritis was present at a particular

location but osteoarthritis was present at a level the level with osteoarthritis
was injection.

Purpose

To determine if spinal facet injection is an adequate means of determining the location of

facet pain and adequate means of treating it.

Intervention

Facet joint injection is an excellent minimally invasive means of both diagnosing and treating
lumbar facet arthropathy.

Outcome

Lumbar facet block is an excellent means of determining if a patients pain is due to facet
arthropathy. Not only does it aid in diagnosis but when injected with anesthetic pain relieve
can be achieved immediately. Patients who had not undergone previous surgery had a better
initial response and longer improvement than those who had undergone laminectomy or
spinal fusion. In 29 patients facet syndrome was diagnosed based upon the fact that their
symptoms improved following facet block. Of these, 18 had temporary relief of symptoms, 11
patients achieved long-term therapeutic benefit.

Credits

SUMMARY BY:

Michael Warren, M.D. R3 PGY4_

Diagnostic Radiology
Providence Hospital and Medical Centers.
*FULL CITATION(S): Destouet, J. M., et al. "Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results."
Radiology 145.2 (1982): 321-325.

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