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Saturday, November 16, 2013

Patient Information: Lumbar (low back) Facet Joint Degeneration, Diagnosis - Part II

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                 How is Lumbar Facet Joint Degeneration diagnosed?

Spine specialists use information from the patient history, physical examination and special spinal tests to make this diagnosis:

 
1.     History

Patients often complain of back pain following periods of rest once they resume an activity. Typically patients do not have a history of a specific low-back injury. Patients often feel the symptoms from facet pain come on slowly over time. Spine specialists will try to divide symptoms of disc disease from facet disease while collecting the patient’s history of low-back pain.

 
2.     Physical Exam

On the exam, the pain is usually well localized and has a common pattern to it. The patient is often asked to bend backwards and sideways. Pain in that position points to the facet joint. Here are some examination points:

1.     Palpation (touch and pressure) of the spine
2.     Range of motion (mobility) testing
3.     Flexion and extension maneuvers (forward and backward bending)
4.     Facet Loading Maneuver
5.     Sensation testing in the legs
6.     Strength (motor) testing in the legs
7.     Reflex testing in the legs
3. Imaging

            a. X-Rays 
 
X-Rays can show facet disease if the joint is enlarged and the joint space narrowed. Some facet joints can appear relatively normal on an X-Ray and yet be the source of the patient’s spine pain.




This image is an X-Ray of the low-back (lumbar spine) which shows the Facet Joints.  Each joint is labeled.
 
         b. MRI Scans    
         
MRI technology is best used for softer structures rather than bone anatomy. However, MRI images can show facet joints quite well. It can also be useful to evaluate the disc at the same time to see if more than one possible disease process is present. Bone spurs and cysts of the facet joint can be seen.
 
 This image is an  MRI scan of the low-back (lumbar spine) which shows the Spine in cross-section. The front of the Spine is to the top, the back at the bottom of the Image. The Disc, Nerves and Facet Joint are annotated.

                 c. CT Scans


 
This image is a CT scan of the low-back (lumbar spine) which shows the spine from the side. The front of the spine is to the left. The discs are shown in green located in the front of the spine. The facet joints are pointed out by the arrows.

d.     Nuclear Bone Scans

Bone scans are excellent at showing severe inflammation of the facet joints. However this study is only useful to evaluate bone. It cannot show the other structures of the spine such as discs and spinal nerves.
 
     e.     Diagnostic Lumbar Facet Injection
 
This image is a MRI Scan showing the low-back (lumbar spine) in cross-section. The front of the Spine is to the top, the back at the bottom of the Image. The Disc and Facet Joints are labeled. Two needles are shown placed into the Facet Joints. Medication (green) has been injected into the joints.
 
 
For diagnostic reasons, sometimes the facet joint is anesthetized with a local anesthetic and the patient’s response to the injected evaluated. This can be done very soon after the injection while the anesthetic is still active.
The injection is done with the help of an X-Ray machine to see the joints.
 
f.     Lumbar Medial Branch Block 
A medial branch block is an injection done with local anesthetics to block the nerves traveling to the facet joint. The patient is then evaluated to see if the pain has improved or is eliminated.
 
 
This image is a MRI Scan showing the low-back (lumbar spine) in cross-section. The front of the Spine is to the top, the back at the bottom of the Image. The Disc and Facet Joints are labeled. A Needle has been placed next to the Facet Nerve shown in yellow. Medication can be injected to block the function of this Nerve.
 
 
 
 
 
In the next Patient Education Blog we will feature Treatments for Lumbar Facet Joint Degeneration!
 
 

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Medical Media Images does NOT dispense medical or legal advice. Our images, text and any content cannot be used for diagnosis or treatment of a medical condition. All Images and content are for information purposes only. You must consult with your physician if you need medical advice. Medical Media Images is not a substitute for medical advice.
 
 
 

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