Thoracic Facet Joint Interventions

Among chronic pain disorders, pain arising from various structures of the spine constitutes the majority of the problems, with a lifetime prevalence of 54–80%. Among these, thoracic pain has been reported as a significant problem even though the prevalence of chronic upper- and mid-back pain is relatively small, specifically in interventional pain management settings, ranging from 3% to 22%. The role of thoracic facet joints as a cause of chronic upper- or mid-back pain has been described since 1987, followed by description of thoracic pain patterns. Subsequently, utilizing controlled comparative local anesthetic blocks, the prevalence of thoracic facet joint pain has been shown to be 34–48% of patients in select patients suffering with chronic mid-back and upper back pain. Multiple modalities of treatments have been employed in managing thoracic pain similar to cervical and lumbar regions with intraarticular injections, medial branch nerve blocks, and medial branch nerve neurotomy. The available evidence based on systematic reviews and guidelines derived from RCTs and observational studies showed Level III evidence with weak to moderate strength recommendation for thoracic radiofrequency ablation, Level II evidence with moderate strength of recommendation for thoracic facet joint nerve blocks, and Level III evidence with weak to moderate strength of recommendation for thoracic intraarticular facet joint injections.