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Background: Lumbar facet joint is an important element of spinal “three-joint complex”. Whether there is a relationship between strange structure of facet joint and adolescent lumbar disc herniation (ALDH) is nonetheless controversial, and the current research is mainly centered on adults. Objective: To find out the normal lumbar facet joints between 13 and 18 years old to provide anatomical basis for early diagnosis and therapy of lumbar disc herniation. Methods: CT imaging information of 32 sufferers with lumbar disc herniation aged from 13 to 18 years old in Inner Mongolia have been collected as the ALDH group, and 62 wholesome subjects in the equal period had been chosen as the normal group. Uncooked records of continuous scanning lumbar tomography pix were imported into MIMICS 21.0 for evaluation and size in DICOM format. The parameters include facet joint height, facet joint width, et al. Results: 1. The left and right transverse angle of L5S1 segment in the ALDH group were (52.41 ± 9.2) ° and (55.99 ± 10.91) ° (P

BACKGROUND Lumbar facet joint syndrome (LFJS) is a pain condition arising from lumbar facet joint diseases. Treatments of LFJS includes patient education, oral medication, bed rest, physical therapy, and procedural interventions. For some refractory cases that fail conservative therapies, dorsal ramus medial brunch radiofrequency ablation is warranted. However, as nerve fibers can regenerate, their efficacy is impermanent, and the recurrence rate is relatively high. Considering synovial impingement is a paramount pathogenesis of LFJS, in this case, we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope. As the culprit hyperplastic joint capsule was excised, it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment. CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS. She complained of low back pain and right buttock pain for half a year. The patient was placed in the prone position. After disinfection and draping, a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process. Subsequently, a guidewire, dilating tubes, and a working cannula was inserted successively. The spinal endoscope was positioned in the working cannula. Under the endoscope, the microvascular tissue, muscle tissue attached on the L5 inferior articular process and S1 superior articular process, as well as the capsule and minor portion of the inferior articular process were removed. After the joint space was clear and no bleeding points existed, the endoscope and working cannula were shifted, and the incision was sutured. After treatment, the symptoms were completely relieved. The patient was pain-free during the follow-up period of 6 mo. CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS, especially for cases caused by synovial impingement.

This work aimed to explore the relationship between spine surgery lumbar facet joint (LFJ) and lumbar disc herniation (LDH) via compressed sensing algorithm-based MRI images to analyze the clinical symptoms of patients with residual neurological symptoms after LDH. Under weighted BM3D denoising, Epigraph method was introduced to establish the novel CSMRI reconstruction algorithm (BEMRI). 127 patients with LDH were taken as the research objects. The BEMRI algorithm was compared with others regarding peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM). Patients’ bilateral LFJ angles were compared. The relationships between LFJ angles, lumbar disc degeneration, and LFJ degeneration were analyzed. It turned out that the PSNR and SSIM of BEMRI algorithm were evidently superior to those of other algorithms. The proportion of patients with grade IV degeneration was at most 31.76%. Lumbar disc grading was positively correlated with change grading of LFJ degeneration ( P < 0.001 ). LFJ asymmetry was positively correlated with LFJ degeneration grade and LDH ( P < 0.001 ). Incidence of residual neurological symptoms in patients aged 61–70 years was as high as 63.77%. The proportion of patients with severe urinary excretion disorders was 71.96%. Therefore, the BEMRI algorithm improved the quality of MRI images. Degeneration of LDH was positively correlated with degeneration of LFJ. Asymmetry of LFJ was notably positively correlated with the degeneration of LFJ and LDH. Patients aged 61–70 years had a high incidence of residual neurological symptoms after surgery, most of which were manifested as urinary excretion disorders.

Lumbosacral radiculopathy is very common presentation in old age people. Of the more common causes, the rarest is the presence of Lumbar intrasynovial cysts (LISCs). This case report of a 64 year old patient presenting with low back pain radiating to left leg and presence of a LISC (MRI finding) at L4-L5 has set a very good example for considering FGPCR for treatment. The patient reported 90% relief in pain after the procedure. So FGPCR can be considered before proceeding for surgery.

The aim of the present study was to develop a novel animal model of lumbar facet joint osteoarthritis induced by persistent compressive injury. An intraspinal compression spring was randomly implanted into either the L4/5 or the L5/6 spinal segments of 40 Sprague Dawley (SD) rats to induce compression. Sham-operations were used in the other segment of the same rats as the control levels. The animals were sacrificed at 7, 14, 28, 42 and 56 days after surgery, prior to the radiological confirmation of the spring location. Degeneration of the lumbar facet joints was evaluated by macroscopic observation in addition to histological and immunohistological analyses. The results of this present study revealed the absence of spring dislocation during the entire observation period. Macroscopic and Osteoarthritis Research Society International scores of the compression levels were found to be higher in the compression levels compared with those noted in the control levels (P

To establish the incidence and define the nature of complications occurring following image-guided musculoskeletal injections at our institution. All patients undergoing image-guided musculoskeletal injection during the study period (16/3/2016 to 24/01/2020) were included. Departmental records were reviewed to identify all patients describing possible complications following injection, what therapy was required (if any) and what the outcome was. No patients were excluded. Complications were classified as minor or major. Injections were categorised as follows: cervical spine, lumbar facet joint, lumbar nerve root, caudal epidural and ‘other’. The complication rate for each individual category of procedure was compared with the combined complication rate for all other categories by constructing contingency tables and using Fisher’s exact test. A total of 8226 patients underwent image-guided musculoskeletal injections within the study period. Exactly 100 patients were identified as having reported a complication, producing an overall complication rate of 1.2%. One complication was categorised as ‘major’, with the patient requiring expedited surgery. The remainder (99 patients) were categorised as having experienced minor complications. The incidence of complications after ‘other’ injections was significantly greater than for other categories of injection (1.86%, p = 0.028). There was no significant difference in the complication rate for cervical spine (0.93%, p = 0.257), lumbar nerve root (0.85%, p = 0.401), lumbar facet joint (0.67%, p = 0.326) or caudal epidural (1.29%, p = 0.687) injections. ‘Other’ injections were subsequently further sub-categorised by anatomical site and imaging modality used. Glenohumeral (2.97%, p = 0.0361) and sacro-iliac (3.51%, p = 0.0498) joint injections were associated with a significantly increased risk of complications. There was no difference in the incidence of complications with fluoroscopic or ultrasound guidance. In conclusion, image-guided musculoskeletal injections are safe and well-tolerated procedures. Complications are rare, occurring in just 1.2% of patients. 99% of complications are minor, either not requiring intervention or resolving with simple supportive treatment.

Lumbar facet joint osteoarthritis (LFJ OA) is regarded as one of the common causes of low back pain (LBP). The pathogenesis and underlying mechanism of this disease are largely unknown, there is still no effective disease-modifying therapy. This study aims to investigate the efficacy of exosomes derived from bone marrow mesenchymal stem cells (BMSCs) on the pathogenesis and behavioral signs of LBP in the LFJ OA mouse model. The pathogenetic change in cartilage and aberrant nerve invasion in the subchondral bone of LFJ in a mouse model after treatment with BMSC-exosomes was evaluated. BMSC-exosomes could relieve pain via abrogation of aberrant CGRP-positive nerve and abnormal H-type vessel formation in the subchondral bone of LFJ. Moreover, BMSC-exosomes attenuated cartilage degeneration and inhibited tartrate-resistant acid phosphatase expression and RANKL-RANK-TRAF6 signaling activation to facilitate subchondral bone remodeling. These results indicated that BMSC-exosomes could relive behavioral signs of LBP and pathological processes in LFJ OA. BMSC-exosomes have a prominent protective effect and might be a potential therapeutic option for the treatment of LFJ OA causing LBP. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:670-679, 2020.

Tenosynovial giant cell tumor rarely affects the facet joints of the spine. We describe FDG PET/CT findings in a case of tenosynovial giant cell tumor arising from the left L2 to L3 facet joint. The tumor caused osteolytic bone destruction of the facet joint and showed intense FDG uptake with SUVmax of 10.4. This case indicates tenosynovial giant cell tumor should be included in the differential diagnosis of abnormal facet joint FDG accumulation.

The lumbar facet joint (LFJ) osteoarthritis (OA) model that highly mimics the clinical conditions was established and evaluated.Here, we innovatively constructed and evaluated the aberrant mechanical loading-related LFJ OA model.LFJ is the only true synovial joint in a functional spinal unit in mammals. The LFJ osteoarthritis is considered to contribute 15% to 45% of low back pain. The establish of animal models highly mimicking the clinical conditions is a useful tool for the investigation of LFJ OA. However, the previously established animal models damaged the LFJ structure directly, which did not demonstrate the effect of aberrant mechanical loading on the development of LFJ osteoarthritis.In the present study, an animal model for LFJ degeneration was established by the unilateral osteotomy of LFJ (OLFJ) in L4/5 unit to induce the spine instability. Then, the change of contralateral LFJ was evaluated by morphological and molecular biological techniques.We showed that the OLFJ induced instability accelerated the cartilage degeneration of the contralateral LFJ. Importantly, the SRμCT elucidated that the three-dimensional structure of the subchondral bone changed in contralateral LFJ, indicated as the abnormity of bone volume/total volume ratio (BV/TV), trabecular pattern factor (Tb. Pf), and the trabecular thickness (Tb. Th). Immunostaining further demonstrated the uncoupled osteoclastic bone resorption, and bone formation in the subchondral bone of contralateral LFJ, indicated as increased activity of osteoclast, osteoblast, and Type H vessels.We develop a novel LFJ OA model demonstrating the effect of abnormal mechanical instability on the degeneration of LFJ. This LFJ degeneration model that highly mimics the clinical conditions is a valuable tool to investigate the LFJ osteoarthritis.N/A.

Objective: To examine the relationship between changes in lumbar spine facet joint (FJ) orientation and chronic low back pain (CLBP). Methods: We retrospectively analyzed lumbar spine CT and MRI images of 98 patients referred for localized paraspinal CLBP and 98 age-and sex-matched asymptomatic individuals as controls. They were divided into four age groups (A

Purpose Evaluate the correlation between lumbar facet joint tropism, lumbar facet joint degeneration, and intervertebral disc degeneration. Methods Forty-two of facet joints were evaluated histologically and radiologically. Results The correlation between facet joint tropism and histologic, CT, and MRI grading was −0.159 (P = 0.339), 0.025 (P = 0.226) and −0.270 (P = 0.102), respectively. The correlation between facet joint tropism and intervertebral disc MRI grading was 0.346 (P = 0.033), and that between facet joint and intervertebral disc MRI grading was 0.208 (P = 0.210). Conclusions Facet joint tropism was correlated with intervertebral disc degeneration but not with facet joint degeneration.

Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure; 85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p < 0.001). Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique; CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.

Aim: Low back pain is a leading cause of patient disability in the USA. Our goal was to determine association between patient characteristics and their response to lumbar medial branch block, radiofrequency ablation of medial nerves or lumbar facet joint injections. Materials & methods: Medical records for the first 100 patients who underwent lumbar medial branch block, radiofrequency ablation of lumbar medial nerves or lumbar facet joint injections between 1 September 2019 and 31 March 2020 were reviewed and demographic data were recorded. Results: At the 3-month post-procedure visit, positive responders were significantly more likely to be non obese patients (BMI

Low back pain (LBP) is a common condition. It is estimated that 84% of adults will present LBP symptoms at some point in their lives. Rarely, however, is LPB an indication of a serious medical condition, requiring further investigation. The treatment of non-specific LBP is based on non-pharmacological strategies, e.g., non-steroidal anti-inflammatory drugs (NSAID) or skeletal muscle relaxants. The use of epidural steroid injection (ESI) or facet joint injections relieves pain originating from degenerative spine disorders or a disk herniation, thereby providing rapid pain improvement, despite considerable long-term outcomes. Although rare, ESI complications can occur, and infections are infrequently described. This paper describes a rare case of an abscess in the psoas muscle, secondary to facet joint lumbar block. We report a male aged between 30 and 40 years old with LBP, who was submitted to a facet joint and ESI. The procedure evolved into a spinal infection of the psoas muscle. In addition, we present a brief literature review on psoas infections after spinal injection. Infection post facet joint lumbar block is very rare, with few publications in the literature. Early detection and the aggressive broad-spectrum antibiotic course must be initiated until adequate cultures are obtained and antibiotics prolong to at least four weeks.

Lumbar facet joints (LFJs) are diarthrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with multifaceted biomechanical and functional characteristics. They are theorized as structures of crucial clinical significance since their degenerative morphologic alterations are frequently related to emergence of low back pain. Despite the emerging interest in describing LFJs anatomy in recent years, precise description of LFJs innervation remains controversial. In this comprehensive review, anatomy and biomechanical importance of LFJs and associated adjacent extra-articular structures are thoroughly presented. Furthermore, LFJs innervation in respect to current literature data is punctually analysed. Knowledge of anatomy and innervation LFJs of critical importance for clinicians and spine surgeons, so that patients are properly evaluated and related therapeutic procedures are rationally performed.

Objective To better understand the unexpected spread of contrast medium observed by conventional fluoroscopic X-ray images during standard neuraxial techniques used in the treatment of pain. The support of 3D reconstruction of MRI images of structures within the lumbar spine was used to better understand the space of Okada. Methods Lumbar facet joint and epidural corticosteroid injections in five patients under fluoroscopic guidance with loss of resistance to air or saline to identify the facet joints or epidural space. Next, in a retrospective study, the authors examined the retrodural space of Okada and the neighboring tissues with 3D reconstruction of spinal MRIs of seven patients without any demonstrable spinal pathology to better understand the characteristics of the space of Okada. Results Contrast medium spread to the ipsilateral and contralateral sides was observed in five patients. The contralateral spread was thought to be through the retrodural space of Okada, which is a potential space between the anterior surface of the vertebral lamina and the posterior surface of the ligamentum flavum. It facilitates communication between the contralateral articular facet joints of the spine. Conclusions This study provides new evidence for the existence of the space of Okada where an unexpected contralateral spread occurred following facet joint and attempted epidural injection. The 3D reconstructions of MRIs may help us better understand the nature of the retrodural space of Okada and its clinical implications.

Objective To compare the efficacy of different radiofrequency techniques (thermal, pulsed, and cooled radiofrequency) for treating lumbar facet joint (LFJ) or sacroiliac joint (SIJ) pain. Patients and methods The inclusion criteria were as follows: (1) age > 18 years; (2) patients suffering from LFJ or SIJ pain; and (3) patients receiving radiofrequency treatments. Four electronic databases, including Pubmed, Embase, Cochrane Library, and ISI Web of Knowledge were systematically searched from inception until December 2019 for relevant articles. The search was conducted on 2 January 2020. When the outcomes among articles showed heterogeneity, then a random-effects model was adopted to calculate the effect size; otherwise, a fixed-effects model was adopted. Results All the three techniques showed significant improvements in LFJ or SIJ pain for up to 12 months compared with the baseline level. However, no significant differences among the three techniques were observed at any follow-up visits except for possibly a trend for variance in efficacy. For treating LFJ pain, cooled radiofrequency was the most effective, followed by thermal radiofrequency and then pulsed radiofrequency as the least respectively for the follow-up visit at 6 months. No serious complications were reported after receiving treatment using the three techniques. Conclusion Sequentially, cooled radiofrequency followed by thermal radiofrequency and then pulsed radiofrequency for treating LFJ pain were identified as most to least effective at the 6-month follow-up.

Background Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). Methods From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. Results The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. Conclusion FT may play a more important role in the pathogenesis of chronic LBP.

Lumbar facet joint injections are performed for chronic facet-related low back pain. This chapter provides a step-by-step guide on how to perform this intervention safely and shows all the relevant C-arm and needle positions that needs to be demonstrated during the Fellow of Interventional Pain Practice (FIPP) exam administered by the World Institute of Pain (WIP). Both native and edited high-quality images are included, so the fluoroscopy anatomy is more easily understood.

Lower Back Pain is one of the leading causes of disability globally. Its degradation to patients’ standing stability has been reported in the past. The goal of the current study was to evaluate the influence of immediate pain relief enabled by a lumbar facet joint anesthetic injection on patients’ standing stability. A total of 91 chronic LBP patients were recruited, each patient performed standing balance tests both before and after a lumbar facet nerve block treatment while their dynamic center of pressure data were recorded and compared. Results of our study showed that after the injection, participants showed 10% smaller total excursion and up to 30% smaller sway area. These results suggested patients’ balance might be used as an objective measurement to evaluate pain reduction among LBP patients.

In this article, we present the latest knowledge of the anatomy and functional anatomy of dorso-lumbar posterior joints (DLPJ) and their pathologies. After a reminder of embryology we specify the morphology of the DLPJ with the help of the work of Masharawi and Louis highlighting among others a constant asymmetry and different characteristics at each level. The morphological peculiarities of DLPJ allow to understand their participation in the vertical and horizontal stability and dynamics of the DL spine. The innervation of DLPJ is described. We end with a reminder of the most common pathologies of lumbar PJ.

Neuraxial anesthesia and analgesia techniques (spinal, epidural, and combined spinal epidural) are used for intraoperative anesthesia, postoperative pain control, and the management of chronic pain and in the peripartum period. Traditionally, these procedures are performed using anatomical landmarks. This involves the location of nerves in relation to other anatomic structures that can be seen (i.e., bony structures) or palpated (i.e., bony structures and arterial pulses). Ultrasound guidance can further aid in the ease and success of these procedures through direct visualization of neural structures as well as the spread of local anesthetic. In this chapter, we discuss a variety of ultrasound-guided neuraxial procedures including epidural block, paravertebral block, sacroiliac joint injection, lumbar facet joint injection, and epidural blood patch.

We retrospectively evaluated the technical success rate and long-term efficacy of fluoroscopy-guided synovial cyst rupture followed by an intra-articular steroid injection at the post-laminectomy lumbar facet.We selected subjects who had undergone a fluoroscopy-guided synovial cyst rupture with simultaneous intra-articular steroid injection within 6 months of MRI and demonstrated a symptomatic facet joint synovial cyst at the level of a previous lumbar laminectomy. Fourteen patients were enrolled, and we determined whether cyst rupture and symptom improvement were achieved after each procedure. The degrees of symptom improvement were categorized into 4: 1) symptoms improved (30% or more reduction, based on pre-procedural and post-procedural Numerical Pain Rating Scale scores), 2) symptoms not improved, 3) patient underwent surgery after injection, and 4) loss of follow-up.The success rate of percutaneous synovial cyst rupture decreased with repeated procedures (62.5% for the first procedure and 0% to 33.3% for additional procedures). However, 80% of the patients had symptom improvement with the procedures, overall. The surgery rate was 14.3% in 14 patients.For patients with post-laminectomy symptomatic lumbar facet joint synovial cysts, fluoroscopy-guided synovial cyst rupture with intra-articular steroid injection may be an effective and less invasive treatment before considering a surgical approach.요추 후궁절제술 시행 부위 후관절 활액낭에 대해 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술을 시행 받은 환자에 관하여 후향적으로 시술의 성공률 및 임상적 효과를 분석하였다.투시유도 하 경피적 후관절 낭종파열술과 관절 내 스테로이드 주입술을 시행 받은 환자이면서, 시술 전 6개월 이내 촬영한 요추 자기공명영상 상 이전 후궁절제술 부위와 후 관절 활액낭종의 위치가 일치하는 것이 증명된 환자, 그리고 그 낭종의 위치가 신경학적 증상을 설명하는 것으로 판단되는 환자를 대상(14명)으로 하였으며 시술 후 낭종파열의 성공 유무와 증상의 호전 정도를 조사하였다.시술이 반복될수록 낭종파열의 성공률은 감소하였지만(첫 시술에서는 62.5%, 그 이후의 시술에서는 0~33%), 80%의 환자가 시술 후 증상 호전을 보였다. 추적관찰 기간 내 낭종에 대한 수술률은 14.3%였다.요추 후궁절제술 시행 부위 후관절 활액낭에 대한 투시유도 하 경피적 낭종파열술 및 스테로이드 주입술은 효과적인 치료 방법으로서, 수술적 치료를 고려하기 전에 먼저 시도해 볼 수 있다.

Background: Neural blockade of the facet medial branch/L5 dorsal rami with local anesthetic with or without corticosteroid has been used to both diagnose and treat low back pain. Higher concentration lidocaine has been shown to be neurolytic in multiple in vivo, in vitro, and some clinical studies. This may make 10% lidocaine a possible neurolytic agent to prolong pain relief from facet blocks. Objective: Compare neurolytic effects of 10% lidocaine to prolong pain relief compared to bupivacaine/ methylprednisolone (BM) in facet medial branch/L5 dorsal rami blocks (MBB). Methods: Retrospective review of 77 patients who received a 10% lidocaine MBB from after short term relief from MBB with BM. Comparison was made in visual analog scale (VAS) and duration of relief using Wilcoxon signed rank matched pairs test. Results: There was no significant difference between baseline median VAS prior to MBB with BM and 10% lidocaine and median days VAS recorded post each MBB ((P = 0.477). Median VAS immediately after BM MBB (17.5 mm) was not significantly different than after 10% Lidocaine MBB) of 18 mm (P = 0.341). Median duration of relief with 10% lidocaine was greater at 14 days versus BM at 3.5 days (P = 0.001). There was no significant correlation between the volume of 10% lidocaine at each level and performance measures: % change VAS post lidocaine MBB (P= 0.529), duration lidocaine MBB (P = 935), VAS pre-RFTC (P = 0.683). Limitation: Retrospective, small study. Conclusion: Ten percent lidocaine was moderately effective neurolytic agent with longer duration than BM. Key words: Lidocaine, facet joint, neurolysis, low back pain

Low back pain (LBP) is more prevalent among postmenopausal women than men. Ovariectomy (OVX) is an established animal model that mimics the estrogen deficiency of postmenopausal women. Little is known about the three-dimensional (3D) morphologic properties of cartilage and subchondral bone changes in the lumbar facet joint (LFJ) of an OVX mouse model.The purpose of this study was to characterize the 3D morphologic change of cartilage and subchondral bone in the LFJ of an OVX mouse model.Three-dimensional visualization and a histologic study on degenerative changes in cartilage and subchondral bone in the LFJ of an OVX mouse model were conducted.Ovariectomy is performed to mimic postmenopausal changes in adult female mice. We present an imaging tool for 3D visualization of the pathologic characteristics of cartilage and subchondral bone changes LFJ degradation using propagation-based phase-contrast computed tomography (PPCT). The samples were further dissected, fixed, and stained for histologic examination.Propagation-based phase-contrast computed tomography imaging provides a 3D visualization of altered cartilage with a simultaneous high detail of the subchondral bone abnormalities in an OVX LFJ model. A quantitative analysis demonstrated that the cartilage volume, the surface area, and thickness were decreased in the OVX group compared with the control group (p.05). Meanwhile, these decreases were accompanied by an obvious destruction of the subchondral bone surface and a loss of trabecular bone in the OVX group (p.05). The delineation of the 3D pathologic changes in the PPCT imaging was confirmed by a histopathologic method with Safranin-O staining. Tartrate-resistant acid phosphatase staining revealed an increased number of osteoclasts in the subchondral bone of the OVX mice compared with that of the control group.These results demonstrated that a mouse model of OVX-induced LFJ osteoarthritis (OA)-like changes was successfully established and showed a good resemblance to the human OA pathology. Propagation-based phase-contrast computed tomography has great potential to becomea powerful 3D imaging method to comprehensively characterize LFJ OA and to effectively monitor therapeutics. Moreover, degenerative LFJ possesses a severe morphologic change in the subchondral bone, may be the source of postmenopausal LBP, and has the potential to be a novel therapeutic target for LBP treatment.

Facet joint steroid injections are used to treat chronic low back pain. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections.The study cohort included 5 patients undergoing fluoroscopically guided intra-articular lumbar facet joint injections at a pain medicine specialty clinic. Blood was collected prior to the injections and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injections.The terminal elimination half-life of triamcinolone in a noncompartmental analysis was 213 hours. The peak median triamcinolone concentration of 3.6 ng/mL was detected within 24 hours after the injections. Serum cortisol levels were30 ng/mL for an average of 4.4 days. The maximum effect of triamcinolone on cortisol suppression was observed with triamcinolone serum levels of1.9 ng/mL.The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.

We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4–L5 level, and loose bodies in the left L4–L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4–L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient’s symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.

Introduction Postsurgical Lumbar facet joint syndrome (PLFJS) is a clinical entity characterized by acute or chronic lumbar pain which can irradiate to the lower extremities but never with a dermatomal pattern in postsurgical patients of lumbar surgery. The diagnosis and treatment are with a Diagnostic Facet Block (DFB). This study describes the outcome of patients undergoing DFB after lumbar surgery and compares the results with patients without surgery. Methods An analytic and longitudinal study with patients over 18 years old between January 2018 and January 2020. For the comparative analysis, we performed two groups: non-surgical lumbar facet joint syndrome (NSLFJS) and PLFJS. Results The general prevalence of PLFJS in our population was 12.5%. The results after DBF showed a significant decrease in the Oswestry percentage and pain according to the Visual Analog Scale(VAS) for the NSLFJS and PLFJS groups between the 3 surgical stages (pre-DFB, post-DFB at 6 weeks and post-DFB at 6 months), but no significant differences between the 2 groups. Discussion The VAS and Oswestry reported a significant improvement in both groups of patients. The innervation of the lumbar facet joints causes pain, this is secondary to the pathological neural activity of facet arthritis that arises because of chronic postsurgical inflammation or chronic degenerative changes. Conclusion The origin of the LFJS is the arthrosis of the facet, originated by postsurgical or degenerative changes. DFB is effectivefor decreasing pain of facet joint origin in patients with previous lumbar surgery.

Study design Descriptive approach to accessing the lumbar facet joint by superior recess. Objective This study is aimed to describe an approach to accessing the lumbar facet joint through targeting the superior recess during lumbar facet joint injections. Summary of background data Lumbar facet joint injections are routinely performed for both the diagnosis and treatment of chronic low back pain. Previous studies either did not specify which part of the joint to target, or recommended targeting the inferior aspect of the joint to access the inferior recess. One study did mention the superior recess as an alternative to injecting the inferior recess, but none has focused on description of the technique. This is the first time this technique has been described. Materials and methods The records and fluoroscopic images were reviewed for all patients over a period of 9 months (January-September 2012) using the proposed technique. This resulted in a total of 48 patients; 15 men, 29 women, and a total of 117 facet joint intra-articular injections. Among these 48 patients, injections were repeated in total of 4 cases. The average time of injections among 4 repeat cases was 121 days. The success of the procedure was confirmed with an arthrogram demonstrating contrast flowing from the superior recess inferiorly through the joint space. Results Successful access of the lumbar facet joint through puncture of the superior recess was seen in 114 cases, with 3 unsuccessful attempts to enter facet joints due to osteophytes at involved levels. There were no complications observed during the procedure. Conclusions We find this approach to be highly successful, safe, and well tolerated by the patient and recommend it as a technique for access of the lumbar facet joint in those patients in whom direct puncture of the inferior recess is difficult.

PURPOSE To assess the feasibility of axial T2 , T2*, and T1 ρ mapping of lumbar facet joint (LFJ) cartilage for evaluation of early degeneration. MATERIALS AND METHODS We examined a total of 176 LFJs from 21 volunteers using axial T2 , T2*, and T1 ρ mapping with a 3.0T magnetic resonance imaging (MRI) scanner. All LFJs were measured and grouped according to the presence of low back pain (LBP), the Weishaupt grading system, and the Pfirrmann grade of the adjacent intervertebral disk (IVD). T2 , T2*, and T1 ρ values were analyzed and compared among the different groups. RESULTS Low interobserver agreement was found in the Weishaupt grading of LFJs (κ = 0.161). The T1 ρ values of LFJs were significantly different between adjacent two Pfirrmann grade of disks (grade I 50.15 ± 3.63 msec / grade II 53.27 ± 3.80 msec, P = 0.002; grade II 53.27 ± 3.80 msec / grade III 58.40 ± 4.17 msec, P

Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation.Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks.All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed.Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.Tradizionalmente, le iniezioni delle faccette articolari (FJI) sono state eseguite sotto guida fluoroscopica o tomografia computerizzata (TC), principalmente a causa della posizione anatomica profonda e la presenza di reperi ossei. L’imaging di fusione permette di accoppiare le immagine ecografiche con quelle TC o di risonanza magnetica (RM) corrispondenti, ottenute da un precedente esame diagnostico e riformattate in tempo reale in base al piano di scansione ecografico. Questa tecnica permette di coniugare la visione panoramica e l’elevato dettaglio anatomico della RM o TC con la praticità della guida ecografica senza ulteriore esposizione del paziente a radiazioni ionizzanti.Trentotto pazienti (24 femmine, età media ± DS: 64 ± 9 anni) hanno ricevuto FJI guidata da fusione ecografia-RM di 1 ml di una miscela di anestetico locale e corticosteroide utilizzando una apparecchiatura ecografica (Logiq E9, GE Healthcare) dotata di tecnologia fusion. Nei primi 28 pazienti il posizionamento dell’ago è stato confermato mediante esame TC a bassa dose. Il dolore dei pazienti è stato registrato utilizzando una scala analogica visiva (VAS), al tempo 0 e dopo 2, 4 e 8 settimane.Tutte le iniezioni fusion guidate sono state eseguite con successo. In 96 su 112 iniezioni è stato raggiunto lo spazio intra-articolare (precisione: 85,7%). La VAS è diminuita significativamente dopo la procedura in tutti i pazienti, senza differenze tra chi ha ricevuto il controllo CT del posizionamento degli aghi e chi non lo ha ricevuto. Non sono state osservate complicanze maggiori.L’iniezione fusion ecografia-RM guidata delle faccette articolari artrosiche rappresenta una opzione terapeutica sicura ed efficace.Tradizionalmente, le iniezioni delle faccette articolari (FJI) sono state eseguite sotto guida fluoroscopica o tomografia computerizzata (TC), principalmente a causa della posizione anatomica profonda e la presenza di reperi ossei. L’imaging di fusione permette di accoppiare le immagine ecografiche con quelle TC o di risonanza magnetica (RM) corrispondenti, ottenute da un precedente esame diagnostico e riformattate in tempo reale in base al piano di scansione ecografico. Questa tecnica permette di coniugare la visione panoramica e l’elevato dettaglio anatomico della RM o TC con la praticità della guida ecografica senza ulteriore esposizione del paziente a radiazioni ionizzanti.Trentotto pazienti (24 femmine, età media ± DS: 64 ± 9 anni) hanno ricevuto FJI guidata da fusione ecografia-RM di 1 ml di una miscela di anestetico locale e corticosteroide utilizzando una apparecchiatura ecografica (Logiq E9, GE Healthcare) dotata di tecnologia fusion. Nei primi 28 pazienti il posizionamento dell’ago è stato confermato mediante esame TC a bassa dose. Il dolore dei pazienti è stato registrato utilizzando una scala analogica visiva (VAS), al tempo 0 e dopo 2, 4 e 8 settimane.Tutte le iniezioni fusion guidate sono state eseguite con successo. In 96 su 112 iniezioni è stato raggiunto lo spazio intra-articolare (precisione: 85,7%). La VAS è diminuita significativamente dopo la procedura in tutti i pazienti, senza differenze tra chi ha ricevuto il controllo CT del posizionamento degli aghi e chi non lo ha ricevuto. Non sono state osservate complicanze maggiori.L’iniezione fusion ecografia-RM guidata delle faccette articolari artrosiche rappresenta una opzione terapeutica sicura ed efficace.

Septic arthritis of the facet joint is an extremely rare condition, even more in young immunocompetent patients. There have been approximately only 40 cases of this entity reported worldwide. Here, the authors present a 16-year-old male patient with lower back pain, fever, and cephalea. Blood cultures and cerebrospinal fluid analysis confirmed methicillin-sensitive Staphylococcus aureus infection, and magnetic resonance imaging showed septic arthritis of the lumbar left facet joint L3 and epidural abscess. Intravenous oxacillin was administered, and the patient improved. No other treatment was required.

Background Juxtafacet cysts (JFCs) are uncommon spinal lesions that can cause neural compression and are typically managed surgically. Rarely, JFCs can spontaneously resolve. Case Description We present the case of a spontaneously resolving right L4/5 JFC in an otherwise fit and well 60-year-old female. She presented with progressive chronic lower back pain and intermittent sciatica. She had no neurologic deficit. The patient was keen to avoid surgical intervention. After 19 months her symptoms had significantly improved, and repeat magnetic resonance image demonstrated complete resolution of the lesion. Conclusions While surgery to remove a JFC ± spinal stabilization remains the mainstay and definitive treatment for symptomatic JFCs, patients without neurologic deficit may be safely managed conservatively pending possible spontaneous resolution. Spontaneous resolution may reflect the natural history of the condition.

Recurrent lumbar disc herniation (rLDH) is one of the major problems when surgically treating patients with LDH. Data on previous studies investigated the associations between facet joint parameters and rLDH appear only rarely in the literature. This study's objective was to evaluate the association between facet joint parameters [facet orientation (FO) and facet tropism (FT)] and rLDH. From June 2005 to January 2014, 346 patients having single-level lumbar disc herniation (LDH), who underwent surgery, were included in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group). According to 25%, 50% and 75% quantiles of FO, all the cases were divided into 4 subgroups (＜42°, 42～45°, 46～49°, and ＞49°). Cases were divided into 3 groups according to different range of FT (＜3°, 3～4° and ＞4°). The relationships between the facet joint parameters and rLDH were evaluated. All cases in the study were followed up for more than 5 years postoperatively. The recurrence rates of different FO groups were statistically significant (P 0.001). With the decrease of FO, the risk of rLDH increases continuously. Also, there were statistically significant recurrence rates in different FT groups (P 0.001), which showed the incidence of rLDH increases gradually with the increase of FT. Facet joint parameters significantly influence the biomechanics of the corresponding segment. Facet joint parameters may play a more important role in the pathogenesis of rLDH.

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters. A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured. Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1. Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.

Lumbar facet joint osteoarthritis (FJOA) caused by degenerative change(s) is considered to be the main cause of facet joint-origin low back pain (LBP). Intra-articular lumbar facet joint (IA LFJ) corticosteroid injection is widely used for controlling pain induced by FJOA. In the current study, the outcomes of IA LFJ corticosteroid injection were evaluated according to the severity of FJOA. A total of 50 patients who received IA LFJ corticosteroid injections for the treatment of LFJ pain were recruited. Patients were classified into three groups according to the severity of FJOA, which was indicated during a lumbar axial MRI. A total of 10 patients were assigned to group A (patients with mild FJOA), 27 to group B (patients with moderate FJOA) and 13 to group C (patients with severe FJOA). Pain intensity was evaluated using a numerical rating scale (NRS) prior to treatment and at 1, 2 and 3 months after treatment. A total of 26 (52%) patients experienced successful treatment outcomes (defined as >50% reduction in NRS score at 3 months). Patients in all groups demonstrated a significant decrease in NRS scores at 1, 2 and 3 months after IA LFJ corticosteroid injection compared with the pre-treatment score (P

This is a retrospective study.The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures.Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts.We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4-L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.

OBJECTIVE: To report in vivo measurements of lumbar facet joint subchondral bone mineral density used in the description of facet joint loading patterns and to interrogate if low-back pain is associated with changes in subchondral bone mineral density. MATERIALS AND METHODS: In vivo measurements of lumbar facet joint subchondral bone mineral density (L1/2 to L5/S1) in Hounsfield units were performed on 89 volunteers (56 controls and 33 with low back pain) by computed tomography osteoabsorptiometry at subchondral regions between 1.5 mm and 2.5 mm below the joint surface. The facet surface was divided in five topographic zones: cranial, lateral, caudal, medial and central. RESULTS: 1,780 facet joint surfaces were analyzed. Facets were denser (p

Facet joint blocks have long been used in the diagnosis and management of spinal pain syndrome.

A congenital absence of the lumbar facet joint is a rare reported condition. This is the case of a 32-year-old male patient presenting with severe low back pain radiating to his right lower limb. Physical examination revealed no motor deficits, but right lower limb numbness was reported over dorsum aspect of the right foot. No other sensory or motor disturbances were reported or found on exam. Imaging studies, consisting of a spine MRI and spine CT scan with 3D reconstruction, revealed the absence of the right L5-S1 zygapophyseal joint. The patient was treated conservatively with resolution of his symptoms on one-month follow-up.

Introduction: The facet joints are the only synovial joint of spine and undergo osteoarthritic changes referred to as facet joint arthrosis (FJA). The arthrosis is akin to arthritic changes in any other synovial joint of the body and may manifest as back pain or may remain asymptomatic throughout life. The causes for pain manifestation in FJA are manifold but there is paucity of literature in defining reasons to remain asymptomatic even with a deranged pathology at the joint. Thus the aim of the study was to assess the prevalence of asymptomatic FJA and define its relation with respect to age, gender and vertebral level on CT evaluation and discuss the pertinent anatomy around each spinal motion segment which prevents manifestation of pain. Material & Methods: A total of 100 asymptomatic subjects were selected on basis of a low back pain questionnaire within age range of 20-70 years, reporting to radiology department for CT abdomen. The individuals were categorized as per the following age groups; 20-35yrs as young; 36-50 as middle and 51-70 as old age groups. All five lumbar vertebral levels with their facet joints were analysed for evidences of degenerative grades and their severity, in total selected subjects. The images obtained were further assessed on image analysis software for distribution as per the age-groups, gender and prevalence with respect to vertebral level. Results: A total of 136 (27.2%) levels in 43(43%) spines were found to have FJA. The highest prevalence (43.3%) of asymptomatic FJA was observed in the middle age group with involvement of multiple spinal motion segments and with grade 4 severity. Conclusion: Prevalence of severe grades of asymptomatic FJA in middle age group suggests the possible role of certain muscle groups in maintaining an appropriate posture in spite of on-going degenerative processes.

Background The purpose of this study was to investigate the feasibility, accuracy and efficiency of the facet joint injections in the lumbar spine by ultrasound guided versus lose dose computed tomography (CT) guidance. Methods First the examination on the joint space of the facet joints of the lumbar spine was obtained by the ultrasound in 10 patients. Second forty patients were randomized assigned into two groups: ultrasound group and low dose CT group. Comparison was made in the clinical efficiency between the ultrasound-guided group and CT group. The feasibility, accuracy and efficiency of the ultrasound-guided lumbar facet joint injections were also evaluated. Results A total of 88 lumbar facet joints from L1 to S1 were clearly visualized in the 10 patients. Both the ultrasound and the CT measurements showed the same average depth and lateral distance to the reference point (P > 0.05). And 86.5% of the facet joint injections (64/74) were correctly performed under the ultrasound guidance in the first time. The exact placement of the needle tips was evaluated by CT. After the lumbar facet joint injections, the clinical efficiency was almost the same in the ultrasound-guided group as in the CT group. Conclusions The lumbar facet joint space can be accurately demonstrated by ultrasound. The ultrasound-guided facet joint injection in the lumbar spine obtained almost the same satisfactory feasibility, accuracy and clinical efficiency compared with low dose CT. Ultrasound technique could provide the real-time monitoring. Trial registration This study was registered on Chinese Clinical Trial Registry (ChiCTR1800018819, retrospective registered on 11/10/2018).

Spinal synovial cysts are benign protrusions of facet joint capsules caused by degenerative spondylosis, most frequently involving the L4–5 level, and commonly lead to symptoms of back pain, radiculopathy and neurogenic claudication. Although percutaneous treatment via facet joint steroid injection with cyst rupture can provide significant symptom relief, cyst rupture is not always achievable via an indirect trans-facet approach due to limited access from severe degenerative changes. In this case, we describe a successful approach to direct cyst access using a laser-guided navigational software in a patient with severe facet joint osteophytosis. We provide a brief review of literature.

Introduction: Lumbar facet joint pain accounts for 5-15% of the cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low level trauma, leading to inflammation and stretching of the joint capsule. Patients and Methods: In this descriptive study 76 patients who were diagnosed, after a diagnostic block, as having lumbar facet joint pain were evaluated by their age, sex, and body mass index (BMI). Data were collected according to a checklist and entered to SPSS version 16. Results: The mean age of the participants was 48.53 years; the participants included 44 women and 32 men. Lumbar facet joint pain was more frequent in the age range of 40-55 years. With respect to BMI, lumbar facet joint pain was most frequently seen in patients with BMI of 24.5-29.5 kg/m 2 (40.8%). Conclusion: Based on our findings, the chances of developing lumbar facet joint pain is more in women who are between 40 years and 55 years of age and whose BMI is 24.5-29.5 kg/m 2 .

In human medicine, spinal pain and radiculopathy are commonly managed by computed tomography (CT)-guided facet joint injections and by transforaminal or translaminar epidural injections. In dogs, CT-guided lumbosacral epidural or lumbar facet joint injections have not been described. The aim of this experimental, ex vivo, feasibility study was to develop techniques and to assess their difficulty and accuracy. Two canine cadavers were used to establish the techniques and eight cadavers to assess difficulty and accuracy. Contrast medium was injected and a CT scan was performed after each injection. Accuracy was assessed according to epidural or joint space contrast opacification. Difficulty was classified as easy, moderately difficult, or difficult, based on the number of CT scans needed to guide insertion of the needle. A total of six translaminar and five transforaminal epidural and 53 joint injections were performed. Translaminar injections had a high success rate (100%), were highly accurate (75%), and easy to perform (100%). Transforaminal injections had an moderately high success rate (75%), were accurate (75%), and moderately difficult to perform (100%). Success rate of facet joint injections was 62% and was higher for larger facet joints, such as L7-S1. Accuracy of facet joint injections ranged from accurate (37-62%) to highly accurate (25%) depending on the volume injected. In 77% of cases, injections were moderately difficult to perform. Possible complications of epidural and facet joint injections were subarachnoid and vertebral venous plexus puncture and periarticular spread, respectively. Further studies are suggested to evaluate in vivo feasibility and safety of these techniques.