The vertebral bones articulate with each other by two zygapophyseal joints above and below its level.  These joints help keep the spinal bones together and ideally prevent shifting of the spinal column.  The zygapophyseal joints are informally known as the facet joints and they are a major source of chronic low back pain.  They are true joints, covered by a capsule and with synovial fluid between.  Just like the knee joint, but much smaller, these joints are prone to arthritis and can benefit from injections with steroids.

 

Patients with pain arising from their facet joints typically will complain about pain across their low back and may experience overlying muscle spasms.  It can be painful to stand erect or to lean backward and twist, and can be relieved by leaning  forward.  Lying down on their backs can be a problem as well, but this can be relieved by putting a pillow under the knees.  

 

As previously stated, patients with pain arising from their facet joints can benefit from joint injection.  This is done with the aide of live X-ray (fluoroscopy).  It is impossible to predetermine the success of the injection.  Some patients will experience complete relief for life.  Others may only benefit from the local anesthetic in the injection, and once worn off, does not feel any long lasting relief from the steroids.  If you are the latter, then the sensory nerves that innervate the joints can be "burned" by way of radio frequency ablation.  The main take home message is that there is most likely another solution down the algorithm for pain control.