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Facet Blocks
Conrad Pun, MD; Donald V. La Barge, III, MD, MBA
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Facet joint block: Anesthetic ± corticosteroid injection into cervical, thoracic, or lumbar facet joint
            • Study to evaluate and treat pain referable to facet joint

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Things to Do

                              • Things to Avoid

                                OUTCOMES

                                • Problems

                                  • Complications

                                    • Expected Outcome

                                      Selected References

                                      1. Maas ET et al: Randomized controlled trials reflected clinical practice when comparing the course of low back pain symptoms in similar populations. J Clin Epidemiol. 116:122-32, 2019
                                      2. Urits I et al: Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 23(3):23, 2019
                                      3. Cohen SP et al: Effectiveness of lumbar facet joint blocks and predictive value before radiofrequency denervation: the facet treatment study (FACTS), a randomized, controlled clinical trial. Anesthesiology. 129(3):517-35, 2018
                                      4. Lee JH et al: Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 21(5):449-68, 2018
                                      5. Manchikanti L et al: Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain. 31(1):27-38, 2018
                                      6. Kennedy DJ et al: Detection of intravascular injection during lumbar medial branch blocks: a comparison of aspiration, live fluoroscopy, and digital subtraction technology. Pain Med. 17(6):1031-6, 2016
                                      7. Boswell MV et al: A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 18(4):E497-533, 2015
                                      8. Iannuccilli JD et al: Interventional spine procedures for management of chronic low back pain-a primer. Semin Intervent Radiol. 30(3):307-17, 2013
                                      9. Weininger M et al: Accuracy of CT guidance of lumbar facet joint block. AJR Am J Roentgenol. 200(3):673-6, 2013
                                      10. Fotiadou A et al: Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. a prospective study. Skeletal Radiol. 41(9):1081-5, 2012
                                      11. Manchikanti L et al: A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 1. Diagnostic interventions. Pain Physician. 13(3):E141-74, 2010
                                      12. Manchikanti L et al: A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Physician. 13(4):E215-64, 2010
                                      13. Manchikanti L et al: Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain. Pain Physician. 12(4):E71-120, 2009
                                      14. Martha JF et al: Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J. 9(11):899-904, 2009
                                      15. Boswell MV et al: A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 10(1):229-53, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              TERMINOLOGY

                                              • Definitions

                                                • Facet joint block: Anesthetic ± corticosteroid injection into cervical, thoracic, or lumbar facet joint
                                                • Study to evaluate and treat pain referable to facet joint

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Things to Do

                                                                  • Things to Avoid

                                                                    OUTCOMES

                                                                    • Problems

                                                                      • Complications

                                                                        • Expected Outcome

                                                                          Selected References

                                                                          1. Maas ET et al: Randomized controlled trials reflected clinical practice when comparing the course of low back pain symptoms in similar populations. J Clin Epidemiol. 116:122-32, 2019
                                                                          2. Urits I et al: Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 23(3):23, 2019
                                                                          3. Cohen SP et al: Effectiveness of lumbar facet joint blocks and predictive value before radiofrequency denervation: the facet treatment study (FACTS), a randomized, controlled clinical trial. Anesthesiology. 129(3):517-35, 2018
                                                                          4. Lee JH et al: Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 21(5):449-68, 2018
                                                                          5. Manchikanti L et al: Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain. 31(1):27-38, 2018
                                                                          6. Kennedy DJ et al: Detection of intravascular injection during lumbar medial branch blocks: a comparison of aspiration, live fluoroscopy, and digital subtraction technology. Pain Med. 17(6):1031-6, 2016
                                                                          7. Boswell MV et al: A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 18(4):E497-533, 2015
                                                                          8. Iannuccilli JD et al: Interventional spine procedures for management of chronic low back pain-a primer. Semin Intervent Radiol. 30(3):307-17, 2013
                                                                          9. Weininger M et al: Accuracy of CT guidance of lumbar facet joint block. AJR Am J Roentgenol. 200(3):673-6, 2013
                                                                          10. Fotiadou A et al: Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. a prospective study. Skeletal Radiol. 41(9):1081-5, 2012
                                                                          11. Manchikanti L et al: A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 1. Diagnostic interventions. Pain Physician. 13(3):E141-74, 2010
                                                                          12. Manchikanti L et al: A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Physician. 13(4):E215-64, 2010
                                                                          13. Manchikanti L et al: Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain. Pain Physician. 12(4):E71-120, 2009
                                                                          14. Martha JF et al: Outcome of percutaneous rupture of lumbar synovial cysts: a case series of 101 patients. Spine J. 9(11):899-904, 2009
                                                                          15. Boswell MV et al: A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 10(1):229-53, 2007