Facet (zygapophyseal) joint injections and medial branch blocks
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
The zygapophyseal facet joints are regarded as a common source of spinal pain, particularly in the lumbar and cervical regions.10,11,13,14,15 The clinical diagnosis of zygapophyseal joint pain is poorly defined and nonspecific. Features of zygapophyseal joint pain include: deep, dull, aching pain;uni- or bilateral;paravertebral tenderness;associated muscle spasm;lateral bending or rotational movements increase pain intensity;extension rather than flexion movements increase pain intensity;Valsalva maneuver and straight-leg raising (SLR) do not affect pain intensity;segmental referral pattern in relation to the joint of origin.
Intradiscal Heating
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
A fluoroscopic examination confirms segmentation and determines the appropriate level for catheter placement. In the AP view, the fluoroscopy tube is rotated until the inferior vertebral endplate of the target interspace is parallel to the fluoroscopy beam. The fluoroscopic beam is axially rotated until the zygapophyseal joint space is located midway between the anterior and posterior vertebral margins. In this view, the insertion point is lateral to the lateral margin of the superior articular process (Fig. 1). The insertion point is marked on the skin. As the distance between the opposite superior articular processes increases at lower levels, the usual distance from the midline increases from about two to three fingerbreadths at the T12–L1 level to four to five fingerbreadths (~6 cm) at the L5–S1 level. Because of the iliac crest and increased interfacetal distance, at the L5–S1 level, the fluoroscopy tube is rotated only far enough to bring the zygapophyseal joint space approximately 25% of the distance between the anterior and posterior vertebral margins (Fig. 2).
Neuroanatomy overview
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Together with the intervertebral discs and spinal ligaments, the facets connect adjacent vertebrae and are responsible for mechanical stability, facilitate the transmission of loads in the spine as well as control of the direction and amplitude of movement. Their orientation and configuration vary as with other spine elements, depending on the region and required motion. The facet articulation, also known as zygapophyseal joint, is formed by the inferior facet of the superior vertebra meeting the superior facet of the inferior vertebra. As such, each vertebral level has two superior and two inferior facets, and the bone segment between the superior and inferior facets is referred to as pars interarticularis. The facets are then symmetrically positioned relative to the midsagittal plane and have a ligamentous capsule that encloses the joint space (Jaumard et al., 2011).
An incoherent HIFU transducer for treatment of the medial branch nerve: Numerical study and in vivo validation
Published in International Journal of Hyperthermia, 2020
J. Chen, S. LeBlang, A. Hananel, R. Aginsky, J. Perez, M. Gofeld, Y. Shir, J. F. Aubry
The first line treatment of chronic low back pain includes oral non-opioid medication, physiotherapy and lifestyle changes. If these fail, targeted injections of steroids into the joint and sensory nerve ablations are therapeutic alternatives [3–8]. Zygapophyseal joint denervation is achieved by ablation of the medial branch nerves (MBN) supplying the joint. The MBN can be targeted and treated in a controlled manner with various methods. The most common procedure is thermal radiofrequency ablation (RFA), where an operator uses X-ray fluoroscopy to correctly position a cannula where the lumbar medial branch of the targeted vertebra is located [3–8]. The cannula causes the tissue temperature near the tip to increase and cause an oval-shaped tissue coagulation at the target site. Despite its effectiveness, this procedure has side effects and complications. The most common side effects are pain and discomfort associated with percutaneous insertion of the radiofrequency cannula [3–8]. More serious complications include bleeding and infections. Thus, a noninvasive alternative with the same efficacy is desirable.
Three-step Reduction Therapy of Integrated Chinese and Western Medicine for Thoracolumbar Burst Fracture
Published in Journal of Investigative Surgery, 2019
Wang Decheng, Shi Hao, Wang Zhongwei, Li Jiaming, Yang Bin, Hai Yong
Spatium intermusculare approach and minimal invasive screw-setting are applied in minimal invasive three-step reduction. It is featured as reducing stripping and tractive of paravertebral muscles, earlier exercise ability after operation, and faster restore of function compared with traditional posterior median approach. Wiltse et al. firstly raised the spatium of paravertebral muscle approach, which is spatium of longissimus and multifidus muscle approach.15 There is no need to apply spinal canal decompression to set screw on pedicle of vertebral arch with above approach. Since natural muscle spatium exists between longissimus and multifidus, blunt dissection can be applied to expose the zygapophyseal joint and root of the transverse process. Then kirschner wire can be drilled through pedicle of vertebral arch, and screw can be put in. Most of studies considered that percutaneous set the srew of pedicle of vertebral arch can reduce complication. There are still some limitations in this study. Firstly, we failed to assess whether 30 cases is enough to confirm the definite results of this methods. Secondly, it is a retrospective study, resulting in many factors that cannot be fully matched.
After-effects of neck muscle vibration on sensorimotor function and pain in neck pain patients and healthy controls – a case-control study
Published in Disability and Rehabilitation, 2019
Konstantin Beinert, Volker Englert, Wolfgang Taube
However, a significant group effect (F3,24 = 5.291, p = 0.03) was detected at the zygapophyseal joint C2/C3. Assessing immediate effects, time and time x group interactions were calculated (time pre/post: F1,24 = 8.08; p < 0.01; time pre/post × groupneck pain/healthy control: F1,24 = 3.28; p = 0.08). Calculation of potential effects after 15 min of neck muscle vibration showed significant time effects (timepre/post15: F1,24 = 6.85; p = 0.01), but no time × group interaction (timepre/post15 × groupneck pain/healthy control: F1,24 = 1.94; p = 0.17). The results for pressure pain threshold at the zygapophyseal joint of C2/C3 are presented in Figure 4.
Related Knowledge Centers
- Articular Processes
- Joint Dislocation
- Joint Stability
- Lumbar Vertebrae
- Synovial Joint
- Vertebra
- Plane Joint
- Functional Spinal Unit
- Meningeal Branches of Spinal Nerve
- Dorsal Ramus of Spinal Nerve