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Therapeutic Efficacy of Facet Joint Blocks

Christoph Gorbach1, Marius R. Schmid2, Achim Elfering3, Juerg Hodler2 and Norbert Boos1

1 Center for Spinal Surgery, University of Zurich, University Hospital Balgrist, Zurich, Switzerland.
2 Department of Radiology, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland.
3 Department of Psychology, University of Berne, Berne, Switzerland.


Figure 1
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  		Fig. 1 —Documentation of fluoroscopic injection. 70-year-old woman with grade 2 degeneration of right L4-L5 facet joint. One needle (curved arrow) is placed in right L3-L4 facet joint. Contrast material has not yet been injected. Second needle (large straight arrow) is placed in right L4-L5 right facet joint. Thin line of contrast material is visible within joint space (small straight arrows) with filling of inferior and superior joint recesses (arrowheads).

 

Figure 2
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  		Fig. 2 —Bilateral grade 0 facet joint osteoarthritis. 48-year-old woman with normal (grade 0) facet joints at L5-S1 level. T2-weighted axial MR image (TR/TE, 4,000/96) shows thin, well-demarcated hyperintense line (straight arrows), presumably caused by combination of intraarticular fluid and superficial parts of articular cartilage. Hypointense line (curved arrows), in part, represents subchondral bone and deep layers of articular cartilage. Findings suggestive of subchondral sclerosis, osteophytes, and cysts are absent.

 

Figure 3
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  		Fig. 3 —Bilateral grade 1 facet joint osteoarthritis. 51-year-old woman with grade 1 facet joint degeneration on both sides at L4-L5 level. Axial T2-weighted MR image (TR/TE, 4,000/96) depicts almost no visible cartilage (arrows). Beginning facet joint hypertrophy (arrowheads) can be seen on left side.

 

Figure 4
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  		Fig. 4 —Grade 2 facet joint osteoarthritis on right side. 51-year-old woman with grade 2 osteoarthritis of right facet joint at L5-S1 level. Axial T2-weighted MR image (TR/TE, 4,000/96) shows joint space narrowing, subchondral sclerosis (curved arrows), and small cyst formation (straight arrow), indicating moderate facet joint degeneration.

 

Figure 5
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  		Fig. 5 —Grade 3 facet joint osteoarthritis on right side. 64-year-old woman with severe bilateral L3-L4 facet joint degeneration. T2-weighed axial MR image (TR/TE 4,000/96) shows facet joint hypertrophy with osteophytes (large straight arrows), subchondral erosions (curved arrow), and hypertrophy of ligamentum flavum (small straight arrows).

 

Figure 6
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  		Fig. 6A —69-year-old woman patient with bilateral grade 1 osteoarthritis at L4-L5 level and lower back pain radiating from back to both thighs. No substantial pain relief after facet joint block. Axial T2-weighted MR image shows minimal medial narrowing of joint space (small arrow) and facet joint hypertrophy (large arrow) on left, indicating grade 1 facet joint degeneration.

 

Figure 7
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  		Fig. 6B —69-year-old woman patient with bilateral grade 1 osteoarthritis at L4-L5 level and lower back pain radiating from back to both thighs. No substantial pain relief after facet joint block. Arthrography image obtained after intraarticular injection of contrast material within joint space (arrow) and within inferior and superior articular recesses (arrowheads).

 

Figure 8
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  		Fig. 7A —51-year-old woman with bilateral L4-L5 facet joint degeneration. She had been experiencing lower back pain for more than 5 years. Bilateral L4-L5 facet joint block resulted in pain relief of 100% for more than 3 months. Patient has grade 2 facet osteoarthritis that is responding well to facet joint block. CT image shows moderate bilateral osteophytes (white arrows) and small subchondral cysts on left side (black arrows).

 

Figure 9
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  		Fig. 7B —51-year-old woman with bilateral L4-L5 facet joint degeneration. She had been experiencing lower back pain for more than 5 years. Bilateral L4-L5 facet joint block resulted in pain relief of 100% for more than 3 months. Patient has grade 2 facet osteoarthritis that is responding well to facet joint block. Arthrography image obtained after intraarticular injection of contrast material within joint space (arrow) and within inferior and superior articular recess (arrowheads).

 

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