Lumbar facet joint arthrography with the posterior approach

Lumbar facet joint (LFJ) arthrography with intraarticular injections of lon g-acting steroids and local anesthetics is routinely used for therapeutic p urposes in selected patients for relief of low back pain, The procedure may also be used for diagnostic reasons to establish the source of such pain. However, because direct access to the LFJ space is not always possible owin g to degenerative changes such as osteophytes, another posterior approach h as been proposed for LFJ arthrography, With the patient in the prone positi on, a spinal needle is inserted vertically into the inferior recess of an L FJ with fluoroscopic guidance and the patient under local anesthesia. To fa cilitate puncture, cushions are placed under the patient's abdomen to flatt en normal lumbar lordosis, which enlarges the inferior recess of the LFJ, U se of cushions also results in a decrease in tissue thickness in the patien t, thereby improving image quality and decreasing radiation exposure, LFJ a rthrography can demonstrate the causative role of facet disease in abnormal ities responsible for low back pain or sciatica and can be performed easily and rapidly with this direct posterior approach.