Facet pain and imaging

[specepic]

---

Members don't see this ad.

How many of you see pts really respond in a meaningful way to facet procedures who have negative imaging i.e. pretty clean looking facets on MRI/XR?

 

[pmrmd]

All the time. Neck pain after rear-enders or acute neck or back pain after some kind of trauma. I have been on the receiving end many times as a youngster after football injuries, weight lifting injuries, etc.

 

[Ligament]

All the time. Neck pain after rear-enders or acute neck or back pain after some kind of trauma. I have been on the receiving end many times as a youngster after football injuries, weight lifting injuries, etc.

Fully agree. Imaging findings do not prove or disprove facetogenic pain. Only fact blocks do. I suspect that often the pain generator is in the facet capsule itself rather than the articular surfaces.

I have done plenty of dual diagnostic MBBs on post MVA patients with pristine facets on MRI, universally after they have failed months to years of meds, PT, etc. Very often find >80% time concordant relief.

 

[pmrmd]

I suspect that often the pain generator is in the facet capsule itself rather than the articular surfaces.

That has already been proven definitively. Kuslich proved this on patients who had surgery just with lidocaine into the tissues and not GETA. Recent Chinese literature also supports whiplash as an injury to the facet capsule and not the articular surfaces.

 

[SSdoc33]

a distinction should be made that in these cases, where the facets look perfect and respond to MBB/RF, are generally after some sort of trauma. the typical 50-70 y/o with back pain when standing pretty universally has SOME z-joint changes on MRI.

i usually just do intra-articular inejctions on these folks, although i know we've had this discussion before