Article References & Abstracts

1.Author Giles LG
Institution Spinal Research Laboratory, Griffith University, Nathan, Brisbane, Queensland.
Title Pathoanatomic studies and clinical significance of lumbosacral zygapophyseal (facet) joints.
Source J Manipulative Physiol Ther 1992 Jan; 15 (1): p36-40
ISSN 0161-4754
Low back pain, with or without pain referred to the leg, affects up to 85% of the population at some time during their lives, which places an enormous economic burden upon many world communities and costs the United States in excess of $13 billion per year. The role of the lumbosacral zygapophyseal (facet, interlamina) joints in the low back "facet" syndrome is briefly discussed, including the clinical symptomatology. The main purpose of this article is to provide preliminary morphological findings of histological studies of human cadaveric lower lumbosacral spines, which show some examples of how the zygapophyseal joints may be involved in dysfunction of mechanical origin. Statistical analysis of the frequency of these findings will be published when the histological study currently under way is completed. While it is not possible to correlate morphological changes in cadavers with pain, it appears that the zygapophyseal joints and their associated soft tissues could be a source of low back pain of mechanical origin, with or without referred pain to the leg.

2.Author Dreyer SJ; Dreyfuss PH
Institution Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, GA, USA.
Title Low back pain and the zygapophysial (facet) joints.
Source Arch Phys Med Rehabil 1996 Mar; 77 (3): p290-300
ISSN 0003-9993
A basic science and clinical review of low back pain due to the lumbar zygapophysial (facet) joints was performed based on a literature search of scientific journals and textbooks. Recent studies estimate that 15% to 40% of chronic low back pain is due to the zygapophysial joints. The histological basis for zygapophysial joint pain has been scientifically established, but the precise clinical etiology remains undetermined. There are no unique identifying features in the history, physical examination, and radiological imaging of patients with pain of lumbar zygapophysial joint origin. Spine physicians diagnose zygapophysial joint pain based on analgesic response to anesthetic injections into the zygapophysial joints or at their nerve supply. Studies on treatment of isolated zygapophysial joint pain are limited. This review summarizes current understanding of lumbar zygapophysial joint disorders while highlighting the need for additional research.

3.Author Tournade A; Patay Z; Krupa P; Tajahmady T; Million S; Braun M
Institution Department of Neuroradiology, Centre Hospitalier Louis Pasteur, Colmar, France.
Title A comparative study of the anatomical, radiological and therapeutic features of the lumbar facet joints.
Source Neuroradiology 1992; 34 (4): p257-61
ISSN 0028-3940
An anatomical study of the lumbar apophyseal joints was carried out to facilitate recognition of facet joint lesions, which we now examine routinely by percutaneous arthrography. Special attention was given to the configuration of the different compartments of the joint space and to its relationships with the contents of the intervertebral foramen. The abnormalities seen on lumbar facet joint arthrography are very varied; two major groups should be stressed: synovial fringe hypertrophy and pseudodiverticular synovial ectasia. The percutaneous approach to lumbar facet joint arthrography allows it to be used a therapeutic measure, with injection of anti-inflammatory drugs into the joint space, the beneficial effects of which were confirmed in our series. The precision, efficiency and cost-effectiveness of this outpatient technique justify and should encourage its more widespread application in the diagnosis and treatment of low back pain.

4. Author Revel M; Poiraudeau S; Auleley GR; Payan C; Denke A; Nguyen M; Chevrot A; Fermanian J
Institution Service de reeducation et de readaptation de l'appareil locomoteur et des pathologies du rachis, Universite Rene Descartes, Paris, France.
Title Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints.
Source Spine 1998 Sep 15; 23 (18): p1972-6; discussion 1977
ISSN 0362-2436
STUDY DESIGN: Prospective randomized study to compare the efficacy of facet joint injection with lidocaine and facet joint injection with saline in two groups of patients with low back pain, with and without clinical criteria that were determined in a previous study to implicate the facet joint as the primary source of the pain. OBJECTIVES: To assess the efficacy of single facet joint anesthesia versus placebo (saline injections) and to determine clinical criteria that are predictive of significant relief of LBP after injection. SUMMARY OF BACKGROUND DATA: There is no syndrome that discriminates between lower back pain caused by facet joint and that caused by other structures. Single or double facet joint anesthesia, and single photon emission computed tomography are expensive and time-consuming procedures for selecting patients in controlled clinical trials with large populations. METHODS: Results of a previous study showed that seven clinical characteristics were more frequent in patients who responded to facet joint anesthesia than in those who did not. In the current study, a group of 43 patients with lower back pain who met at least five criteria were compared with 37 patients who met fewer criteria. Patients randomly received injection of either lidocaine or saline into the lower facet joints. The result was considered positive if more than 75% pain relief was determined by visual analog scale. The patient, the radiologist, and the investigator were blinded. An analysis of variance was used to seek an interaction between clinical group effect and injection effect, and logistic regression analysis to select the best set of variables that would be predictive of minimum pain relief of 75% after the injection. RESULTS: There was a significant interaction between clinical group and injection effect (P = 0.003). In patients with back pain, lidocaine provided greater lower-back pain relief than saline (P = 0.01). Lidocaine also-provided greater pain relief in the back pain group than in the nonpain group (P = 0.02). The presence of five among seven variables (age greater than 65 years and pain that was not exacerbated by coughing, not worsened by hyperextension, not worsened by forward flexion, not worsened when rising from flexion, not worsened by extension-rotation, and well-relieved by recumbency), always including the last item, distinguished 92% of patients responding to lidocaine injection and 80% of those not responding in the lidocaine group. CONCLUSIONS: A set of five clinical characteristics can be used in randomized studies to select lower back pain that will be well relieved by facet joint anesthesia. These characteristics should not, however, be considered as definite diagnostic criteria of lower back pain originating from facet joints.

5. Author Schwarzer AC; Aprill CN; Derby R; Fortin J; Kine G; Bogduk N
Institution Faculty of Medicine, University of Newcastle, Australia.
Title Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity?
Source Spine 1994 May 15; 19 (10): p1132-7
ISSN 0362-2436
STUDY DESIGN. This study is a prospective cross-sectional analytic study. OBJECTIVES. The authors determined the prevalence and clinical features of patients with pain stemming from the lumbar zygapophysial joints. SUMMARY OF BACKGROUND DATA. Previous studies have demonstrated a wide range of prevalence for zygapophysial joint pain and conflicting results with regard to clinical signs. METHODS. One hundred and seventy-six consecutive patients with chronic low back pain were investigated with a series of screening zygapophysial joint blocks using lignocaine and confirmatory blocks using bupivacaine. RESULTS. Forty-seven percent of patients had a definite or greater response to the screening injection at one or more levels but only 15% had a 50% or greater response to a confirmatory block. Response to zygapophysial joint injection was not associated with any single clinical feature or set of clinical features. CONCLUSIONS. The zygapophysial joint is an important source of pain but the existence of a "facet syndrome" must be questioned.

6. Author Demaerel P; Wilms G; Goffin J; Baert AL
Institution Department of Radiology, University Hospitals KU Leuven, Belgium.
Title Osteoarthritis of the facet joints and its role in low-back pain: evaluation with conventional tomography.
Source J Belge Radiol 1992 Apr; 75 (2): p81-6
ISSN 0021-7646
Thirty-seven patients with chronic low-back pain and an atypical irradiation to one or both legs were examined by conventional tomography of the facet joints. A disc herniation was excluded by computed tomography (CT) in 31 patients. The facet joints were considered normal in 4 patients. Four grades of facet joint disease were used to classify the pathological changes. Correlation of the radiological findings with the facet joint block by injection of a local anesthetic was obtained in 12 patients. It appears that conventional tomography is a very sensitive technique as it is possible to detect even discrete abnormalities of the facet joints. However, as it is time consuming and high in radiation dose, the examinations should be reserved for patients with a normal CT examination of the lumbar spine in whom there still remains a high suspicion of facet joint disease.

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