The fibrous capsule of each lumbar zygapophyseal (facet) joint, reinforced posterolaterally by the ligamentum flavum and anteriorly by the joint capsule proper, enclosing the synovial facet joint.
Maintains the facet joint articulation and contains the synovial fluid. The joint capsule is richly innervated by the medial branches of the dorsal rami, making it a primary source of back pain.
Lumbar facet joint pain is diagnosed by medial branch nerve block under fluoroscopy. Facet joint injection with corticosteroid reduces acute inflammatory arthritis. Radiofrequency ablation of the medial branches provides 6-12 months of pain relief for facetogenic back pain. Synovial cysts (ganglion) arising from the joint capsule can compress the nerve root.
Facet joint capsule degeneration producing a synovial cyst that herniates posteromedially into the spinal canal and compresses the traversing nerve root, causing radiculopathy requiring cyst excision.
Facet joint capsule degeneration producing medial branch-distributed back pain reproduced by extension and ipsilateral rotation, treated by medial branch blocks and radiofrequency ablation.
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