Iranian Journal of Radiology

Published by: Kowsar

Ultrasound Guidance for Interventional Pain Management of Lumbar Facet Joint Pain: An Anatomical and Clinical Study

Masoud Hashemi 1 , Seyed Mohammad Jazayeri 2 , Asadollah Saadat Niaki 3 , Mahshid Nikooseresht 4 , * , Alireza Hosseinpanah 5 , Seyed Sajad Razavi 1 , Farshad Farivar 1 and Farideh Shahandeh 6
Authors Information
1 Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Orthopedics, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Anesthesiology, Beasat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran
5 Fellowship of Pain, Tehran, Iran
6 Department of Radiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Article information
  • Iranian Journal of Radiology: January 2017, 14 (1); e13464
  • Published Online: June 28, 2016
  • Article Type: Research Article
  • Received: November 18, 2015
  • Revised: December 7, 2015
  • Accepted: January 18, 2016
  • DOI: 10.5812/iranjradiol.28297

To Cite: Hashemi M, Jazayeri S M, Niaki A S, Nikooseresht M, Hosseinpanah A, et al. Ultrasound Guidance for Interventional Pain Management of Lumbar Facet Joint Pain: An Anatomical and Clinical Study, Iran J Radiol. 2017 ; 14(1):e13464. doi: 10.5812/iranjradiol.28297.

Copyright © 2016, Tehran University of Medical Sciences and Iranian Society of Radiology. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion
  • 1. Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis. 1995; 54(2): 100-6[PubMed]
  • 2. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976). 1994; 19(10): 1132-7[PubMed]
  • 3. Schwarzer AC, Wang SC, O'Driscoll D, Harrington T, Bogduk N, Laurent R. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine (Phila Pa 1976). 1995; 20(8): 907-12[PubMed]
  • 4. Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007; 10(1): 229-53[PubMed]
  • 5. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007; 106(3): 591-614[PubMed]
  • 6. Sowa G. Facet-mediated pain. Dis Mon. 2005; 51(1): 18-33[DOI][PubMed]
  • 7. Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976). 2003; 28(20): 2419-25[DOI][PubMed]
  • 8. Carrino JA, Morrison WB, Parker L, Schweitzer ME, Levin DC, Sunshine JH. Spinal injection procedures: volume, provider distribution, and reimbursement in the U.S. medicare population from 1993 to 1999. Radiology. 2002; 225(3): 723-9[DOI][PubMed]
  • 9. Kim PS. Role of injection therapy: review of indications for trigger point injections, regional blocks, facet joint injections, and intra-articular injections. Curr Opin Rheumatol. 2002; 14(1): 52-7[PubMed]
  • 10. Peng PW, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med. 2009; 34(5): 458-74[DOI][PubMed]
  • 11. Greher M, Scharbert G, Kamolz LP, Beck H, Gustorff B, Kirchmair L, et al. Ultrasound-guided lumbar facet nerve block: a sonoanatomic study of a new methodologic approach. Anesthesiology. 2004; 100(5): 1242-8[PubMed]
  • 12. Shim JK, Moon JC, Yoon KB, Kim WO, Yoon DM. Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med. 2006; 31(5): 451-4[DOI][PubMed]
  • 13. Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol. 2007; 188(5): 1218-21[DOI][PubMed]
  • 14. Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003; 24(4): 351-5[DOI][PubMed]
  • 15. Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain. 1997; 13(4): 285-302[PubMed]
  • 16. Dreyfuss P, Schwarzer AC, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine (Phila Pa 1976). 1997; 22(8): 895-902[PubMed]
  • 17. Intensity P. Modified oswestry low back pain disability questionnaire. Physiotherapy. 1980; 66: 271-3
  • 18. Zhou Y, Singh N, Abdi S, Wu J, Crawford J, Furgang FA. Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals. Pain Physician. 2005; 8(1): 49-53[PubMed]
  • 19. Peterson MK, Millar FA, Sheppard DG. Ultrasound-guided nerve blocks. Br J Anaesth. 2002; 88(5): 621-4[PubMed]
  • 20. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005; 94(1): 7-17[DOI][PubMed]
  • 21. Kirchmair L, Entner T, Kapral S, Mitterschiffthaler G. Ultrasound guidance for the psoas compartment block: an imaging study. Anesth Analg. 2002; 94(3): 706-10[PubMed]
  • 22. Kirchmair L, Entner T, Wissel J, Moriggl B, Kapral S, Mitterschiffthaler G. A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block. Anesth Analg. 2001; 93(2): 477-81[PubMed]
  • 23. Greher M, Kirchmair L, Enna B, Kovacs P, Gustorff B, Kapral S, et al. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology. 2004; 101(5): 1195-200[PubMed]
  • 24. Aguirre DA, Bermudez S, Diaz OM. Spinal CT-guided interventional procedures for management of chronic back pain. J Vasc Interv Radiol. 2005; 16(5): 689-97[DOI][PubMed]
  • 25. 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][PubMed]
  • 26. Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine (Phila Pa 1976). 1984; 9(7): 746-50[PubMed]
  • 27. Lewinnek GE, Warfield CA. Facet joint degeneration as a cause of low back pain. Clin Orthop Relat Res. 1986; (213): 216-22[PubMed]
  • 28. Gorbach C, Schmid MR, Elfering A, Hodler J, Boos N. Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol. 2006; 186(5): 1228-33[DOI][PubMed]
  • 29. Silbergleit R, Brunberg JA, Patel SC, Mehta BA, Aravapalli SR. Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT. Neuroradiology. 1998; 40(10): 664-8[PubMed]
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