Facet Problems: A Surgical Indication?

Abstract

The apophyseal facet joints of the spine are typical diarthrodial joints located in the posterior aspect of the functional spinal unit or “three-joint complex”. They provide motion and stability and protect the neural structures. Indeed, facet problems are a surgical indication, mainly after acute trauma with facet dislocation. However, in the absence of “red flags”, surgical indications are less clear. Studies on nerve blocks indicate that the prevalence of lumbar zygapophysial joint pain among patients with chronic low back pain (LBP) ranges from 15 to 40%. However, a false positive rate of 25–36% has been reported for single nerve blocks. Facet nerve blocks have been shown to have a very high placebo effect. Since the first article on radiofrequency denervation in 1975, the technique has been used increasingly and popularized as the treatment of choice for LBP of facet origin. Two systematic reviews of RCTs, published recently, show conflicting evidence. The close proximity of the facet joints to the nerve root canals makes degeneration of these structures which is an important contribution to spinal stenosis due to facet enlargement or misalignment (degenerative spondylolisthesis). Enlargement of facet joints due to a synovial cyst with or without haemorrhage may cause symptomatic compression of the neural structures and requires surgical decompression.