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Facet Joint Pain: Presentation and Treatment, Is It a Myth?

  • Chapter
Advanced Concepts in Lumbar Degenerative Disk Disease

Abstract

The zygapophysial joints, together with the intervertebral disc, form a functional spine unit. The importance of the zygapophysial joints as a pain generator is often underestimated because the prevalence of zygapophysial joint pain (10–80 %) is difficult to specify. The prevalence increases with age, and it often comes along with other pain sources. Zygapophysial joints are typical synovial joints with a dual nerve supply from the medial branches of the dorsal rami. The joint capsule and the surrounding structures are richly innervated. The stretching of the capsule and loads being transmitted through the joint can cause pain. Degenerative changes are commonly found. Zygapophysial joints are often affected by osteoarthritis and inflammatory processes. Often additional factors including synovial cysts, spondylolisthesis, spinal canal stenosis, and injuries are present. Zygapophysial joint pain is a somatic referred pain. Morning stiffness and pain when moving from a sitting to a standing position are typical. No historic or physical examination variables exist to identify zygapophysial joint pain. Also, radiologic findings do not have a diagnostic value for zygapophysial joint pain. The most accepted method for diagnosing zygapophysial joint pain is controlled medial branch block. It is the most validated of all spinal interventions, although false-positive and false-negative results exist and the degree of pain relief after medial branch blocks remains contentious. The only truly validated treatment is radiofrequency neurotomy. The available techniques vindicate the use of medial branch neurotomy provided that the correct technique is used and patients are selected rigorously using controlled blocks.

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  1. Department of Neurosurgery, Nova Clinic, Eichendorffweg 5, Biberach, 88400, Germany

    Stephan Klessinger MD

  2. Department of Neurosurgery, University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany

    Stephan Klessinger MD

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  1. Neurological and Spine Surgery, Hospital Samaritano, São Paulo, São Paulo, Brazil

    João Luiz Pinheiro-Franco

  2. Rothman Institute, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, USA

    Alexander R. Vaccaro

  3. Cleveland Clinic Neurological Surgery, Cleveland, Ohio, USA

    Edward C. Benzel

  4. Schön Klinik München Harlaching FG Wirbelsäulenchirurgie, München, Germany

    H. Michael Mayer

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Klessinger, S. (2016). Facet Joint Pain: Presentation and Treatment, Is It a Myth?. In: Pinheiro-Franco, J., Vaccaro, A., Benzel, E., Mayer, H. (eds) Advanced Concepts in Lumbar Degenerative Disk Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47756-4_16

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