Facet Joint Anatomy and Approach for Denervation

One of the difficulties in treating back pain is the multiple potential sources of pain, especially those occurring in the same general region. Pain in the low back or buttock may arise from muscle, disc, facet joints, sacroiliac joints, ligaments, etc. Trying to differentiate which structure(s) is responsible for pain presents a challenge. Once identified, the challenge of a viable treatment remains. Similar to the disc, the facets were traditionally thought to have a role in pain production by compressing the nerve roots. Not until years later did the innervation of these structures as well as the role of inflammatory mediators receive attention, and only then did an appreciation for these structures as primary pain generators come about. A spinal segment has frequently been described as a three-joint complex involving the intervertebral disc and the two facet joints. Based on biomechanical theory, many had accepted that facet degeneration is often a secondary occurrence following disc degeneration with a lesser incidence of primary facet injury or degeneration.