Current concepts in evaluation of the lumbar facet joints

The lumbar facet joints have been recognized for many years to be an important source of chronic low back pain with sciatic radiation. The presence of unilateral chronic low back pain with sciatic radiation, but without objective neurological abnormality, is typical of symptomatic lumbar facet arthropathy. Computed tomography is much better able to demonstrate significant lumbar facet joint abnormalities than conventional radiographic examination. Computed tomographic findings in the lumbar facet joints appear to correlate better with clinical relief following intraarticular lumbar facet block than do findings on conventional studies. The combination of computed tomography and fluoroscopically controlled intraarticular lumbar facet block is becoming an important examination sequence in the accurate diagnosis of symptomatic lumbar facet arthropathy. The development of concepts regarding lumbar facet joint abnormalities are reviewed, and implications of the development of new procedures for studying lumbar facet disease in the patient with chronic low back pain and sciatica are discussed.