Lumbar Facet Joint Disease: What, Why, and When?

Abstract

Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP. This narrative review aims to provide an overview of the literature regarding facet joint pain and discusses the utility of medial branch blocks (MBBs) and intra-articular (IA) injections as diagnostic and therapeutic tools prior to radiofrequency ablation (RFA). RFA is considered the gold standard for managing FJP, employing techniques that include precise needle placement and stimulation parameters to disrupt pain signals. Promising alternatives such as cooled RFA and cryodenervation require further research on their long-term efficacy and safety. Endoscopic denervation and multifidus stimulation are emerging therapies that may benefit chronic LBP patients, but additional research is needed to establish their effectiveness. When conservative management fails, RFA provides significant and lasting relief in well-selected patients and has a favourable safety profile. The current literature does not support surgical interventions for FJP management.

Keywords: chronic low back pain; facetogenic low back pain; lumbar facet joint; mechanical back pain; medial branch block; medial branch neurotomy; radiofrequency denervation.

Figure 1

Anterior view of FJP.

Figure 2

Posterior view of FJP.

Figure 3

SPECT-CT of the lumbar spine. Woman with low back pain and a typical presentation of facet joint osteoarthritis on SPECT/CT at the L4–L5 level. Axial CT image (a) and axial (b), sagittal (c), and coronal (d) SPECT/CT images. Courtesy by E.V.d.Kelft.

Figure 4

RFA needle placement. Lateral image. Inclination in relation to the top end plate of L4 24°, L5 40°, and sacrum 57°.

Figure 5

RFA needle placement. A 50-year old woman. Lateral 10° oblique.

Figure 6

FENIX arthroplasty. (A) Detachment of the inserter; the implantation of FENIX^® is completed. (B) Note the perfect fit between the two implants, courtesy of E.V.d.K.