Lumbar facet joints face sagittally, enabling the lumbar spine's primary flexion-extension motion while resisting the rotation that would injure the discs. They transmit approximately 16% of total lumbar compression load in neutral but increasing share in extension. Joint degeneration with disc height loss transfers more load to the facets, producing the extension-worsening pain of facet syndrome.
Lumbar facet syndrome is confirmed by medial branch nerve blocks at two levels — each facet joint is supplied by medial branches from two adjacent levels. Radiofrequency neurotomy provides 6-12 months of sustained relief when blocks confirm facet origin. Zygapophyseal joint osteophytes contributing to foraminal stenosis and radiculopathy require surgical decompression when nerve compromise is present.
Zygapophyseal joint pain confirmed by dual medial branch nerve blocks producing extension-worsened low back pain managed with radiofrequency neurotomy.
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