ABSTRACT
This article is the second article in a two-part review on lumbar facet joint pathology. In this review, we discuss the current concepts and controversies regarding the proper diagnosis and management of patients presenting with presumed facet-mediated lower back pain. All efforts were made to include the most relevant literature from the fields of radiology, orthopaedics, physiatry, and pain management. Our focus in this article is on presenting the evidence supporting or refuting the most commonly employed injection-based therapies for facet-mediated lower back pain.
Subject(s)
Joint Instability/diagnosis , Joint Instability/therapy , Low Back Pain/prevention & control , Lumbar Vertebrae/surgery , Spinal Diseases/diagnosis , Spinal Diseases/therapy , Zygapophyseal Joint/surgery , Arthrography/methods , Diagnostic Imaging/methods , Humans , Joint Instability/complications , Low Back Pain/etiology , Lumbar Vertebrae/diagnostic imaging , Radionuclide Imaging , Spinal Diseases/complications , Zygapophyseal Joint/diagnostic imagingABSTRACT
We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable the reader to better understand the anatomical changes underlying facet-mediated lower back pain. Other less-common, but equally important etiologies of lumbar facet joint degeneration are reviewed. The existing grading systems are discussed with specific reference to the reliability of CT and MR imaging in the diagnosis of lumbar facet osteoarthritis. It is hoped that this discussion will stimulate debate on how best to improve the diagnostic reliability of these tests so as to improve both operative and non-operative treatment outcomes.