GENERAL
Diagnostic facet joint block is a minimally invasive technique that is applied for various diagnostic purposes in patients suffering from chronic lumbar pain and whose clinical examination and history raises the suspicion for facet joint syndrome.
DESCRIPTION OF THE TECHNIQUE
The diagnostic interventional technique is applied under local skin anaesthesia and fluoroscopic guidance. A fine needle is directed to the point from which passes the medial branch of the posterior spinal nerve ramus, innervating the facet joint. Every facet joint is innervated by two such nerve branches. As soon as the tip of the needle touches bone surface and the proper site of the needle is confirmed with fluoroscopy, a long-acting anaesthetic 0,5ml is injected. The same is repeated twice (one for each branch). The diagnostic facet joint block is applied to the cervical and lumbar spine.
PURPOSE OF APPLICATION
If the patient feels significant pain relief for as long as the local anaesthetic action lasts (about 4 hours) and s/he is able to carry out functions that could not do before the block, then the diagnosis is set for facet joint syndrome. In this case, another session follows applying conventional radiofrequency to ablate the nerve branches that innervate the facet joints (medial branches of the spinal nerve dorsal ramus).
MEDICAL INFORMATION SOURCES
1. PAIN PRACTICE JOURNAL
2. BONICA”S MANAGEMENT OF PAIN
3. PAIN PHYSICIAN JOURNAL
4. INTERVENTIONAL PAIN MANAGEMENT BOOK
5. MANUAL OF RF TECHNIQUES (GAUCI)
JOURNAL ARTICLES
Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777 Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396 Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236 Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
