FACET (ZYGAPOPHYSEAL JOINT) NEUROTOMY

Patients often develop problem with the facet joints, more technically named the zygapophyseal joints. These can occur at the lumbar, cervical or thoracic level. Facet problems develop from a number of causes. Facet arthropathy can result from the joints becoming arthritic, mechanically distorted, hypertrophic, or spondylytic. Calcium deposits can further complicate problems. Facet joints are bilateral and each level is innervated by separate medial branches of the Dorsal Nerve Root. These anatomical relationships can be exploited by the injection interventionalist to yield short and long term pain reduction in patients with facet arthropathy.

The joints can be directly blocked with an injection into the joint capsules themselves. Pain relief with arthrpathy is usually short lived, but if the block does work, the patient can be given a set of medial branch blocks, which are blocks of the medial branches of the Dorsal Nerve Root. These nerves only carry a pain signal from the facets. These are two separate procedures that are usually done weeks to months apart to determine if facet neurotomy is feasible. It is important to note that any facet joint is innervated by two levels of the dorsal root and that both the decending and ascending nerves must be blocked. This is important because if the blocks are not done at both the upper and lower medical branches, a complete block will not be attainable.