Lumbar Facet Joints and Intraarticular Injection of Biologics

Among the multiple structures capable of transmitting pain in the lumbar spine resulting in symptoms of low back pain and lower extremity pain, lumbar facet joints are one of the common structures apart from intervertebral discs, sacroiliac joints, nerve root dura, ligaments, fascia, and muscles. Utilizing controlled diagnostic blocks the prevalence of persistent low back pain secondary to the involvement of lumbosacral facet joints has been established as varying from 16% to 41% depending on the type of population and setting studied. Multiple therapeutic modalities in managing lumbar facet joint pain include intraarticular injections with local anesthetics with or without steroids, lumbar therapeutic facet joint nerve blocks, and/or radiofrequency neurotomy. The evidence for diagnostic as well as therapeutic effectiveness of various modalities continues to be debated with good evidence for diagnostic facet joint nerve blocks followed by Level II evidence for therapeutic facet joint nerve blocks and radiofrequency neurotomy with Level III to IV evidence for intraarticular injections. Consequently, multiple other types of interventions are considered including emerging scientific evidence with injection of biologics into intraarticular lumbar facet joints. This chapter provides an overview of lumbar facet joint pain and the potential use of regenerative medicine, specifically platelet-rich plasma (PRP) and medicinal signaling cells or mesenchymal stem cells (MSCs), in managing this condition. This chapter also discusses the anatomy of facet joints and provides technical considerations for performing lumbar facet joint interventions.