Facet Joint Interventions: Fluoroscopy
- DOI:
- 10.1093/med/9780199908004.003.0019
This chapter reviews the diagnosis and treatment of facet joint pain. Fluoroscopic guidance is commonly used to optimize treatment outcomes. The only reliable way to identify a painful facet joint is with image-guided blockade of either the medial branch innervating the joint or the joint itself. Although computed tomography (CT) and ultrasound have been shown to provide reliable landmarks for accurate needle placement, these modalities have limitations. The risks of CT include increased radiation exposure, cost, and an inability to perform real-time contrast injection. While ultrasound provides a convenient and inexpensive way to anesthetize the facet joints or medial branch nerves innervating them, it is unreliable in obese patients, is not as sensitive for detecting intravascular uptake as digital substraction or real-time contrast injection under fluoroscopy, and cannot be reliably used to place an electrode parallel to the course of the nerve, which has been shown to enhance lesion size.
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