Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity.

Please complete the following steps:

  1. Read the article by Cohen and Raja entitled “Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain” on page 591 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.

The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Purpose:  The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.

Target Audience:  Physicians and other medical professionals whose medical specialty is the practice of anesthesia.

Learning Objectives:  After reading this article, participants should have a better understanding of the pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain.

Authors – Steven P. Cohen, M.D., and Srinivasa N. Raja, M.D.

Grants or research support:  Dr. Cohen receives partial salary support from the John P. Murtha Neuroscience and Pain Institute, Johnstown, Pennsylvania, and the US Army. Dr. Raja has unrestricted grants from Allergan, Irvine, California, and Ortho-McNeil, Raritan, New Jersey, and serves as scientific advisor for Fralex Therapeutics, Toronto, Ontario, Canada. He receives salary support from grant No. NS-26363 from the National Institutes of Health, Bethesda, Maryland.

Consultantships or honoraria:  None

Question Writers – Peter L. Bailey, M.D., and Leslie C. Jameson, M.D.

Drs. Bailey and Jameson have no grants, research support, or consultant positions, nor do they receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.

Based on the article by Cohen and Raja entitled “Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain” in the March issue of Anesthesiology, choose the one correct answer for each question:

1. Which of the following descriptions of lumbar facet joints is the most  accurate?

A. They are not true synovial joints.

B. Each joint contains approximately 1–1.5 ml of fluid.

C. The fibrous capsule is arranged to provide maximum resistance to extension.

D. The ligamentum flavum forms part of the capsule posteriorly.

2. Which of the following mechanisms best  explains the increased degeneration of neighboring facet joints when a single level of the lumbar spine is surgically fused?

A. Increased facet joint motion

B. Nerve root injury during surgery

C. Surgery-induced inflammation

D. Loss of vascular supply

3. Which of the following statements concerning lumbar facet joints is most  likely true?

A. They bear most of the axial load in the spine.

B. Each has dual innervation from medial branches of the posterior primary rami at the same level and one level below the joint.

C. They primarily serve a protective role by limiting movement in all planes.

D. They all have the same anatomic orientation.

4. Which of the following is the most  sensitive and specific diagnostic test to identify lumbar facet inflammation as the source of low back pain?

A. History of a torsional injury

B. Paraspinal tenderness to palpation

C. Computed tomography

D. An effective response to local anesthetic block

5. Which of the following statements concerning the pain pattern(s) associated with lumbar facet pain is most  likely true?

A. The synovium is the most likely pain generator.

B. Upper, compared to lower, lumbar facets more commonly produce pain that is referred to the groin.

C. Pain can be referred to below the knee.

D. Pain is never radicular.

6. Which of the following treatment options for lumbar facet pain is least  likely to be successful?

A. Surgery

B. Conservative therapies

C. Local anesthetic blocks

D. Radiofrequency nerve ablation