Minimal invasive methods of diagnostic and treatment of facet-syndrome pain (literature review)


  • Olexandr Perfiliev
  • Volodymyr Radchenko
  • Volodymyr Kutsenko
  • Andrey Popov
  • Artem Skidanov
  • Valentyn Piontkovsky



lumbar spine, painful facet syndrome, medial branches of the posterior branches of the spinal nerves, therapeutic and diagnostic blockages of facet joints, denervation of facet joints, endoscopic denervation


Purpose: on the basis of the analysis of the scientific literature, to study the most significant problems of interventional methods of diagnosis and treatment of painful facet syndrome in lumbar spondylarthrosis, and to determine the ways of their solution.

Methods: publications for the last 20 years from electronic da­tabases PubMed, MEDLINE, articles, monographs, authors ab­stracts, dissertations and other sources of scientific and medical information have been studied. 178 publications on the lumbar pain facet syndrome, 199 — lumbar medial branches of the pos­terior branches of the spinal cord nerves, 1 062 — blockade and denervation of the lumbar arched joints, 7 — their endo­scopic denervation. 74 publications with II and III levels of evi­dence were selected.

Results: an increase in the prevalence of the use of minimally invasive diagnostic blockades and dener­vation of the facets in the lumbar spine resulted in an increase in the number of not only positive, but also unsatisfactory re­sults. It has been established that the innervation of facets has individual anatomical and topographical features of the loca­tion of the nerves, which can influence the results of minimally invasive methods of treatment of the facet syndrome. Selective blockages of the medial branches of the posterior branches of the spinal nerves and intra-articular blockade of the facets, with observance of qualitative control, are effective for short-term treatment of the chronic painful facet syndrome, and de­nervation of the facets in the form of a neurotomy of the said branches under endoscopic control is the most successful method for achieving long-term The main ways of improving mini­mally invasive methods for diagnosis and treatment of painful facet syndrome of lumbar spondylarthrosis have been found.


Manchikanti. L, Pampati. V, Singh V, Falco FJ. Assessment of the escalating growth of facet joint interventions in the medicare population in the United States from 2000 to 2011. Pain Physician. 2013;16(4):E365–78.

Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Gharibo CG, Grami V, Grider JS, Gupta S, Jha SS, Mann DP, Nampiaparampil DE, Sharma ML, Shroyer LN, Singh V, Soin A, Vallejo R, Wargo BW, Hirsch JA. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician. 2015;18(4):E535–82.

Zhou Q, Zhou F, Wang L, Liu K. An investigation on the effect of improved X-rays-guided radiofrequency thermocoagulation denervation on lumbar facet joint syndrome. J Clin Neurol Neurosurg. 2016;148:115–20. doi: 10.1016/j.clineuro.2016.07.018.

Yeung A, Gore S. Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study. Int J Spine Surg. 2014;8. doi: 10.14444/1023

Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997–2006. Spine. 2009;34(19):2077–84. doi: 10.1097/BRS.0b013e3181b1fad1

Manchikanti L. The growth of interventional pain management in the new millennium: a critical analysis of utilization in the medicare population. Pain Physician. 2004;7(4):465–82.

Korzh NA, Yaremenko DA. Medical and organizational aspects of rehabilitationtion of the disabled with consequences of injuries and diseases the musculoskeletal system. Kharkiv: Word, 2014. 228 р. (in Russian)

Prodan AI, Pashchuk AJ, Radchenko VA, Gruntovsky GH. Lumbar spondylosis Kharkov: Base, 1992. 107 p. (in Russian)

Lutsyk A, Kolotov EB. Diagnosis and treatment of spondylosis. Spine Surgery. 2004;1:55-59. (in Russian)

Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982; 165:110–23.

Radchenko VA. Diagnosis and treatment of osteoarthritis bootrestbar joints at lumbar osteochondrosis: abstract. dis. the candidate of medical sciences. Kharkiv, 1988. 27 p. (in Russian)

Gries NC, Berlemann U, Moore RJ, Vernon-Roberts B. Early histologic changes in lower lumbar discs and facet joints and their correlation. J Eur Spine. 2000;9(1):23–9.

Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms prepared by International Association for the Study of Pain, Task Force on Taxonomy. 2nd ed. Seattle: IASP Press, 1994. 222 р.

Binder DS, Nampiaparampil DE. The provocative lumbar facet joint. Current Reviews in Musculoskeletal Medicine. 2009;2(1):15–24. doi: 10.1007/ s12178-008-9039-y

Sirenko AA. Diagnostics, prevention and treatment recurrence of spondyloarthralgia after denervation of the belt. Personal arcuate joints: abstract dis. the candidate of medical sciences. Kharkiv, 2010. 20 p. (in Russian)

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078–93. doi: 10.1097/BRS.0b013e3181a103b1

Bogduk NA, Dreyuss P, Govind J. narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Medicine. 2009;10(6):1035–45. doi: 10.1111/j.1526-4637.2009.00692.x

Moon JY, Lee PB, Kim YC, Choi SP, Sim WS. An alternative distal approach for the lumbar medial branch radiofrequency denervation: a prospective randomized comparative study. Anesth. Analg. 2013;116(5):1133–40. doi: 10.1213/ANE.0b013e31828b35fe

Jeong SY, Kim JS, Choi WS, Hur JW, Ryu KS The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. J Korean Neurosurg. Soc. 2014;56(4):338–43. doi: 10.3340/jkns.2014.56.4.338

Bogduk N, Wilson AS, Tynan WT. The human lumbar dorsal rami. J Anat. 1982;134(2):383–97.

Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med. 2004;5(3):289–98.

Saito T, Steinke H, Miyaki T, Nawa S, Umemoto K, Miyakawa K, Wakao N, Asamoto K, Nakano T. Analysis of the posterior ramus of the lumbar spinal nerve the structure of the posterior ramus of the spinal nerve. Anesthesiology. 2013;118(1):88–94. doi: 10.1097/ ALN.0b013e318272f40a

Chen JD, Hou SX, Peng BG, Shi YM, Wu WW, Li L. Anatomical study of human lumbar spine innervation. Zhonghua Yi Xue Za Zhi. 2007;87(9):602–5.

Steinke H, Saito T, Miyaki T, Oi Y, Itoh M, Spanel-Borowski K. Anatomy of the human thoracolumbar Rami dorsales nervi spinalis. Ann Anat. 2009;191(4):408–16. doi: 10.1016/ j.aanat.2009.04.002

Zhou L, Schneck CD, Shao Z. The anatomy of dorsal ramus nerves and its implications in lower back pain. Neuroscience Medicine. 2012;3:192–201. doi: 10.4236/nm.2012.32025

David S, Devi E. The provocative lumbar facet joint. Curr Rev Musculoskelet Med. 2009;2(1):15–24. doi: 10.1007/s12178-008-9039-y

Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech. 1996;29(9):1117–29.

McLain RF, Pickar JG. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine. 1998;23(2):168–73.

Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591–614. doi: 10.1097/00000542-200703000-00024

Goldthweit J. The lumbosacral articulation: an explanation of many cases of «lumbago», «sciatica» and paraplegia. Boston Med Surg J. 1911;164:365–72.

Chormley R. Low back pain. JAMA. 1933;101:1773–7.

Sak LD, Zubakov EH, Shemetova MV. Facet syndrome of the spine: clinical and structure of diagnostic and minimally invasive techniques treatment. Magnitogorsk, 2001. 100 p. (in Russian)

Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. J Skeletal Radiol. 1999;28(4):215–9.

Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O'Donnell CJ, Hoffmann U, Cole R, Hunter DJ. Facet joint osteoarthritis and low back pain in the community-based population. Spine. 2008;33(23):2560–5. doi: 10.1097/BRS.0b013e318184ef95

Mooney V, Robertson J. The facet syndrome. Clin Orthop. 1976;15:149–56.

Radchenko VA. Using of articular blocks of zygapophyseal joints for the lumbar osteochondrosis. Actual problems of theoretical and practical medicine. 1986;(2):33. (in Russian)

Manchukonda R, Manchikanti KN, Cash KA, Pampati V, Manchikanti L. Facet joint pain in chronic spinal pain: an evaluation of prevalence and false-positive rate of diagnostic blocks. J Spinal Disord Tech. 2007;20(7):539–45. doi: 10.1097/BSD.0b013e3180577812

Marks RC, Houston T, Thulbourne T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain. 1992;49(3):325–8.

Pneumaticos SG, Chatziioannou SN, Hipp JA, Moore WH, Esses SI. Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology. 2006;238(2):693–8. doi: 10.1148/ radiol.2382041930

Fuchs S, Mönikes R, Wohlmeiner A, Heyse T. Intra-articular hyaluronic acid compared with corticoid injections for the treatment of rhizarthrosis. Osteoarthritis Cartilage. 2006;14(1):82–8. doi: 10.1016/ j.joca.2005.07.016

Prodan AI, Kolesnichenko VA, Sirenko AA. et al. Treatment and diagnostic blockade of the vertebral joints: Achievements and perspectives. Litopys travmatologii i otopedii. 2006;(1-2):120-8.

Wu J, Du Z, Lv Y, Zhang J, Xiong W, Wang R, Liu R, Zhang G, Liu Q. A new technique for the treatment of lumbar facet joint syndrome using intra-articular injection with autologous platelet rich plasma. Pain Physician. 2016;19(8):617–25.

Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci. 2010;7(3):124–35.

Cohen SP, Moon JY, Brummett CM, White RL, Larkin TM. Medial branch blocks or intra-articular injections as a prognostic tool before lumbar facet radiofrequency denervation. Reg Anesth Pain Med. 2015;40(4):376–83. doi: 10.1097/aap.0000000000000229.

Cohen SP, Stojanovic MP, Crooks M, Kim P, Schmidt RK, Shields CH, Croll S, Hurley RW. Lumbar zygapophysial (facet) joint radiofrequency denerva¬tion success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis. J Spine. 2008;8(3):498–504. doi: 10.1016/j.spinee.2007.04.022

Ha DH, Shim DM, Kim TK, Kim YM, Choi SS. Comparison of ultrasonography- and fluoroscopy-guided facet joint block in the lumbar spine. Asian Spine J. 2010;4(1):15–22. doi: 10.4184/asj.2010.4.1.15

Park JW, Cheon MW, Lee MH. Phantom study of a new laser-etched needle for improving visibility during ultrasonography-guided lumbar medial branch access with novices. Ann Rehab Med. 2016;40(4):575–82. doi: 10.5535/arm.2016.40.4.575

Amrhein TJ, Joshi AB, Kranz PG. Technique for CT fluoroscopy-guided lumbar medial branch blocks and radiofrequency ablation. AJR Am J Roentgenol. 2016:207(3):631–4. doi:10.2214/ajr.15.15694.

Chaturvedi A, Chaturvedi S, Sivasankar R. Image-guided lumbar facet joint infiltration in nonradicular low back pain. Indian J Radiol Imaging. 2009;19(1):29–34. doi: 10.4103/0971-3026.44522.

Tomé-Bermejo F, Barriga-Martín A, Martin JL. Identifying patients with chronic low back pain likely to benefit from lumbar facet radiofrequency denervation: A prospective study. J Spinal Disord Tech. 2011;24(2):69–75. doi: 10.1097/BSD.0b013e3181dc9969.

Streitberger K, Müller T, Eichenberger U, Trelle S, Curatolo M. Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. Eur Spine J. 2011;20(12):2160–5. doi: 10.1007/s00586-011-1891-6.

Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM&R. 2012;4(9):686–92. doi: 10.1016/j.pmrj.2012.06.007.

Shabat S, Leitner Y, Bartal G, Folman Y. Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older. Clin Interv Aging. 2013;8:737–40. doi: 10.2147/CIA.S44999.

Lakemeier S, Lind M, Schultz W, Fuchs-Winkelmann S, Timmesfeld N, Foelsch C, Peterlein CD. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg. 2013;117(1):228–35. doi: 10.1213/ANE.0b013e3182910c4d.

Rees W. Multiple bilateral subcutaneous zhizolysis of segmental nerves in the treatment of the intervertebral disc syndrome. Ann Gen Pract. 1971;16(1):126–7.

Yilmaz C, Kabatas S, Cansever T, Gulsen S, Coven I, Caner H, Altinors N. Radiofrequency facet joint neurotomy in treatment of facet syndrome. J Spinal Disord Tech. 2010;23(7):480–5. doi: 10.1097/BSD.0b013e3181bf1c76.

Speldewinde GC. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med. 2011;12(2):209–18. doi: 10.1111/j.1526-4637.2010.01022.x.

Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, Rybak L. The lumbar facet joint: A review of current knowledge: part II: Diagnosis and management. Skeletal Radiology. 2011;40(2):149–57. doi: 10.1007/s00256-010-0984-3.

Lu K, Liliang PC, Liang CL, Wang KW, Tsai YD, Chen HJ. Efficacy of conventional and pulsed radiofrequency for treating chronic lumbar facet joint pain. Formosan Journal of Surgery. 2012:45(4):107–12. doi: 10.1016/ j.fjs.2012.06.001.

Derby R, Melnik I, Lee JE, Lee SH. Correlation of lumbar medial branch neurotomy results with diagnostic medial branch block cutoff values to optimize thera¬peutic outcome. Pain Med. 2012;13(12):1533–46. doi: 10.1111/j.1526-4637.2012.01500.x.

Manchikanti L, Pampati S, Cash KA. Making sense of the accuracy of diagnostic lumbar facet joint nerve blocks: An assessment of the implications of 50 % relief, 80 % relief, single block, or controlled diagnostic blocks. Pain Physician. 2010;13(2):133–43.

Rees W. Multiple bilateral subcutaneous zhizolysis of segmental nerves in the treatment of the intervertebral disc syndrome. Ann Gen Pract. 1971;16(1):126–7.

Shealy CN. Facet denervation in the management of back and sciatic pain Clin Orthop Relat Res. 1976;115:157–64.

Gofeld M, Jitendra J, Faclier G. Radiofrequency denervation of the lumbar zygapophysial joints: 10-year prospective clinical audit. Pain Physician. 2007;10(2):291–300.

Shuang F, Hou SX, Zhu JL, Liu Y, Zhou Y, Zhang CL, Tang JG. Clinical anatomy and measurement of the medial branch of the spinal dorsal ramus. Medicine. 2015;94(52):1–5. doi: 10.1097/MD.0000000000002367.

Prodan AI, Sirenko AA, Kolesnichenko VA. Spinal facet joint denervation: pro et contra. Spine Surgery. 2005;3:78-86. (in Russian)

Prodan AI, Benhuss LM, Sirenko AA. The sciatic nerve morphology after local cryotherapy. Orthopedics, traumatology and prostetics. 2010;2:(579):66-72. doi: 10.15674/0030-59872010266-72

Gruntovsky GH, Sirenko AA, Ryabov OV, Levshin AA. Intraoperative denervation as a method of prevention spondiloartritis. Orthopedics, traumatology and prostetics . 2003;4:101-2. (in Russian)

Haufe SM, Mork AR. Endoscopic facet debridement for the treatment of facet arthritic pain- a novel new technique. Int J Med Sci. 2010;7(3):120–3.

Yeung A. Endoscopic medial branch and dorsal ramus rhi¬zotomy for chronic axial back pain: а pilot study. International 25th Jubilee Course on Percutaneus Endoscopic Spine surgery and Complementary Techniques. Zurich, Switzerland, 2007. 27 р.

Siddiqi FN, Romero JA, Hayes V, O’Donnell C. Long-term results of endoscopic dorsal ramus rhizotomy and anatomic variations of the painful lumbar facet joint. Spine J. 2013;13(9):S161. doi: j.spinee.2013.07.407.

Igressa AH, Weber F, Bulmus R, et al. Endoscopic rhizotomy in lumbar facet joint syndrome first results. Eur Spine J. 2013; 22(1):61.

Yeung AT. Endoscopic decompression, foraminalplasty and dorsal rhizotomy for foraminal stenosis and lumbar spondylosis: a hybrid procedure in lieu of fusion. J Neurol Disord. 2016;4(8):1–4. doi: 10.4172/2329-6895.1000322.

Moeller TB, Reif E. Pocket Atlas of Sectional Anatomy Computed Tomography and Magnetic Resonance Imaging: In 3 t. T. 3. The spine, the limbs, joints; translated from English. Yu. E. Draw Nina; under the General editorship of G. E. Trufanova. 2nd ed. Moskow: Medpress-inform, 2013. 344 p. (in Russian)




Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>