• The Korean Journal of Pain
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• 제37권1호
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• pp.3-12
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• 2024

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

• The Korean Journal of Pain
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• 제7권2호
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• pp.292-298
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• 1994

The common disorder called facet syndrome exhibits lower back pain, with or without, radiating pain to buttock and thigh due to facet joint arthropathy. Many physicians have believed that the usual lesion of facet syndrome was an anatomical impairments of facet joint itself. So facet joint block has been known only as a therapeutic and diagnostic modality of facet syndrome. Based on clinical experience and anatomical study, we have concluded varying opinions from common sense about facet syndrome. Pain in the facet joint is supposedly the secondary effect of narrowing of joint space by sustained muscle contracture around joints. We therefore conclude that spasmolytic treatment of muscles connecting the two vertebral articular space would be better for treatment and diagnosis of facet syndrome rather than facet block with local anesthetic and steroid only.

• 대한정형도수물리치료학회지
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• 제15권2호
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• pp.93-97
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• 2009

Anatomy: Facet joint syndrome most often affects the lower back and neck and refers to pain that occurs in the facet joints, which are the connections between the vertebrae in the spine that enable the spine to bend and twist. Many physicians have believed that the usual lesion of facet syndrome was an anatomical impairments of facet joint itself.. Facet joint injection using local anesthetics is a reliable method for the diagnosis and treatment for facet syndrome. Etiology: One of many possible causes is imbalances that can occur in stress levels, hormone levels, and nutritional levels. These imbalances can adversely affect posture, which can lead to neck and back pain. The common disorder called facet syndrome exhibits lower back pain, with or without, radiating pain to buttock and thigh due to facet joint arthropathy. Pain in the facet joint is supposedly the secondary effect of narrowing of joint space by sustained muscle contracture around joints. Syndrome: Facet joint syndrome tends to produce pain or tenderness in the lower back that increases with twisting or arching the body, as well as pain that moves to the buttocks or the back of the thighs. Other symptoms include stiffness or difficulty standing up straight or getting out of a chair. Pain can be felt in other areas such as the shoulders or mid-back area. Treatment: Non-drug treatments include hot packs, ultrasound, electrical stimulation, and therapeutic exercises. Stimulating blood flow using massage or a hot tub may also help. Alternative treatments include yoga and relaxation therapy. If your pain persists after trying these treatments, a surgical procedure called radiofrequency rhizotomy, which destroys the sensory nerves of the joint, may bring relief. Facet joint injection has been helpful in diagnosis and therapy for this facet syndrome. Radiofrequency thermocoagulation of medial branches is known to be an effective method of relieving pain caused by facet joint problems. We conclude that spasmolytic treatment of muscles connecting the two vertebral articular space would be better for treatment and diagnosis of facet syndrome rather than facet block with local anesthetic and steroid only.

• The Korean Journal of Pain
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• 제31권2호
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• pp.87-92
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• 2018

Background: An epidural steroid injection (ESI) is a commonly administered procedure in pain clinics. An unintentional lumbar facet joint injection during interlaminar ESI was reported in a previous study, but there has not been much research on the characteristics of an unintentional lumbar facet joint injection. This study illustrated the imaging features of an unintentional lumbar facet joint injection during an interlaminar ESI and analyzed characteristics of patients who underwent this injection. Methods: From December 2015 to May 2017, we performed 662 lumbar ESIs and we identified 24 cases (21 patients) that underwent a lumbar facet joint injection. We gathered data contrast pattern, needle approach levels and directions, injected facet joint levels and directions, presence of lumbar spine disease as seen on magnetic resonance images (MRI), and histories of lumbar spine surgeries. Results: The contrast pattern in the facet joint has a sigmoid or ovoid contrast pattern confined to the vicinity of the facet joint. The incidence of unintentional lumbar facet joint injection was 3.6%. The mean age was 68.47 years. Among these 21 patients, 14 (66.7%) were injected in the facet joint ipsilaterally to the needle approach. Among the 20 patients who received MRI, all (100%) had central stenosis and 15 patients (75%) had severe stenosis. Conclusions: When the operator performs an interlaminar ESI on patients with central spinal stenosis, the contrast pattern on the fluoroscopy during interlaminar ESI should be carefully examined to distinguish between the epidural space and facet joint.

• The Korean Journal of Pain
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• 제14권2호
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• pp.218-224
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• 2001

Background: Response to diagnostic blocks does not consistently predict the outcome of interventional facet denervation. We investigated the relationship between pain relief by the percutaneous radiofrequency denervation of the lumbar zygapophysial joints with the result of facet joint diagnostic local anesthetic injection in patients with back pain originating from the lumbar zygapophysial joint. Methods: There were 35 patients enrolled, with ranging in age from 25 to 76 years ($52.6{\pm}12.7$ years, mean ${\pm}$ SD). We studied 7 men (20%) and 28 women (80%). All patients underwent double diagnostic block of $L_{3/4}$, $L_{4/5}$ and $L_5-S_1$ facet joint with 0.5% bupivacaine. The 35 patients fell into the following group. (1) Group A (n = 16): those who felt clear relief (pain free with Likert scale) from the double diagnostic block (2) Group B (n = 19): 11 patients who were always equivocal in their response to the double diagnostic block and 8 patients who were either pain free or equivocal in their response to the double diagnostic block. All 11 patients were done the facet joint denervation. The effect on the pain was evaluated with 4 point Likert scale 1, 6 and 12 weeks after the procedure. We evaluated the relationship between the pain response to diagnostic block and the pain relief with facet joint denervation. Results: Significant correlation was observed between the response to diagnostic block and pain relief with facet denervation (P < 0.05). We found no correlation between the categories of spinal operation and pain response to facet denervation (P value > 0.05). Conclusions: A satisfactory result of lumbar facet joint denervation can be obtained in many patients, especillay in patients whose pain were relieved by the diagnostic double facet joint block. It may be said that facet joint denervation for mechanical low back pain using radiofrequency thermocoagulation is a safe, easy, and repeatable technique.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.366-369
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• 2013

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.

• 대한영상의학회지
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• 제85권1호
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• pp.54-76
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• 2024

후관절병증은 퇴행성 추간판 질환 또는 척추관 협착증과 같은 척추 퇴행성 질환과 잘 동반되는 진행성 퇴행성 질환이다. 요추의 후관절병증은 근위부 하지의 통증을 유발할 수 있지만 그 증상과 영상 소견이 비특이적이기 때문에 추간판 탈출증이나 신경근 압박에 의한 통증과 감별이 어렵다. 또한 치료적 요추 후관절 내 스테로이드 주사는 현재까지 그 근거가 낮다고 분류되어 있으나, 다른 여러 연구들에서는 후관절 내 스테로이드 주사의 치료적 효과를 보고하고 있다. 실제 진료 현장에서는 치료적 후관절 내 스테로이드 주사 시술이 증가하고 있는 추세로, 본 종설에서는 후관절 내 주사에 대한 저자들의 경험을 바탕으로 요추 후관절 내 주사의 임상적 유용성 및 시술의 안전성에 대해서 소개하고자 한다.

• Journal of Acupuncture Research
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• 제32권4호
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• pp.187-194
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• 2015

Objectives : The purpose of this study was to observe the correlation between modic type changes 2 and facet joint arthrosis. Methods : We randomly selected the 93 patients with Lumbar MRI films who had been admitted to Haeundae Jaseng Korean Medicine Hospital from January to June 2015. Modic type changes 2 and facet joint arthrosis data were collected and statistically analyzed. Results : In this study, if the findings of the MRI showed modic type changes 2, the cases of facet joint arthrosis increased. Conclusions : There was a significant correlation between modic type changes 2 and facet joint arthrosis.

• The Korean Journal of Pain
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• 제23권2호
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• pp.137-141
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• 2010

Background: Facet joint have been implicated as a source of chronic low back pain. Radiofrequency denervation has demonstrated the most solid evidence. To increase safety and efficacy of treatment, computed tomography (CT) guidance injection has been used in several disease. The purpose of this study was to evaluate the efficacy of CT-guided radiofrequency rhizotomy in the treatment of facet joint pain. Methods: A total of 40 patients were randomized to undergo radiofrequency facet joint denervation under CT guidance or C-arm guidance. All patients were examined visual analogue scale (VAS) score before treatment, 1 month, and 3 months after treatment. Results: The VAS in both groups showed significant improvement over the 1-month interval. No significant difference in the VAS score among the group was observed. Conclusions: In this study there was no significant difference between CT guidance lumbar rhizotomy and C-arm guidance lumbar rhizotomy. Therefore CT-guided radiofrequency denervation of the lumbar facet joint was a minimally invasive technique that appears effective.

• The Korean Journal of Pain
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• 제27권1호
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• pp.43-48
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• 2014

Background: This study tests the hypothesis that of bipolar radiofrequency thermocoagulation of the thoracic facet joint capsule may provide a safe and effect method of pain control from thoracic facet origin. Methods: Among patients suffering from localized mid back pain, nine patients with thoracic facet disease confirmed by magnetic resonance image and diagnostic thoracic facet block were enrolled. Bipolar radiofrequency ablation in the inferior aspect of the thoracic facet joint was done. Visual Analog Scale (VAS) was measured pre-intervention and 1 month post-intervention. Any complications and changes in amount of pain medication were recorded. Results: Significant 47.6% reduction in VAS was noted at 1 month. There were no serious complications. Conclusions: Intra-articular bipolar radiofrequency thermocoagulation of the thoracic facet joint may be a technically easier and valid method of treating mid back pain of thoracic facet origin.