In 1911, Goldthwait first stated that the facet joints were responsible for cases of low back pain and instability (36). Like many clinicians of that time, he was struck by the asymmetry of the facet joints seen on radiography. He believed that the joint asymmetry could cause pain from nerve root pressure (36). An Italian surgeon, Putti, published an article in 1927 that supported Goldthwait's findings and focused specifically on articular facet degeneration as a cause of back pain (37). In 1933, Ghormley was the first to describe facet syndrome, which he defined as lumbosacral pain with or without sciatic pain, particularly occurring suddenly after twisting or rotatory strain of the lumbosacral region (38). In addition, his initial discussion focused on the role of facet joints, not the intervertebral discs, in creating nerve pressure and sciatica. In 1934, however, Mixter and Barr described protrusion of lumbar discs as the most likely cause of low back pain (39). This description then overshadowed the role of the facet joints as a source of low back pain and sciatica.
In 1941, Badgley encouraged clinicians to again focus attention on the facet joints to explain the large numbers of patients with low back pain whose symptoms are not due to a ruptured disc (40). He showed that facet joint pathology could cause symptoms, including radiation of pain into the lower extremity. Badgley was the first clinician to associate facet arthritis with nerve root irritation as a cause of low back pain and sciatica (40). Hirsch and colleagues, in 1963, were the first to demonstrate that low back pain distributed along the sacroiliac and gluteal areas with radiation to the greater trochanter could be induced by injecting hypertonic saline in the region of the facet joints (41). These findings were confirmed by Mooney and Robertson, who in 1976 performed intraarticular facet injections with hypertonic saline and noted that the pain produced could be relieved by intraarticular injection of local anesthetics (42). In addition, Pawl reported the reproduction of pain in patients after injecting hypertonic saline into their cervical facet joints (43).
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