Anatomy:Lumbar facet joints
Lumbar facet pain (Facet syndrome):
Present with back, buttock, or hip pain. The back pain may radiate into buttocks or hips and may worsen with extension. Worse in morning, eases through out the day, worse in hyperextension.
If pain is produced by forward pushing of the pelvis, then it is likely to be facet-mediated pain.
Radiculopathy, leg weakness and numbness are not symptoms of facet syndrome.
Indications:
Diagnosis of pain
Relief of pain
Synovial cysts
Contraindications:
Infection
Bleeding diasthesis
Preparation:
Fasting for 4 hours
No NSAID for 3 days
Anaesthesia:
Local
Sedation might be needed in a few
Procedure:
Oblique position - left = LAO.
C-arm or fluoroscopic guidance
Lumbar triangle
Spinal needle - yellow: needle may curve medially once inside joint. Superior and inferior parts of joint may be less involved and, hence may be easier to access.
40 mg kenelog (triamcinlone), 10 ml 1% lignocaine or 0.25% bupivacaine
Not more than 2ml in lumbar and 1.5ml in cervical region
Contrast may be used to confirm the placement
Injecting more than the joint can decrease the diagnostic accuracy
Complications:
Bleeding, infection, allergic reaction
Transient swelling of the joint may temporarily result in exacerbation of the patient's symptoms.
Results:
Pain relief up to 6 months is observed in 30-50% of patients.
