(ZYGAPOPHYSEAL JOINT) NEUROTOMY
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.
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.