In sclerotogenous facet pain, which structures are involved?

• A. Intervertebral disc
• B. Facets, capsules, dorsal rami
• C. Spinal cord
• D. Nerve roots

Answer: (B)

Sclerotogenous facet pain comes from skeletal components of the spine that are innervated by the dorsal ramus. In facet-related pain, the pain generator is the facet joints themselves and their fibrous capsules. These structures are innervated by the medial branches of the dorsal rami, which carry nociceptive signals from the joint and capsule to the spinal cord. When the facet joint or its capsule is irritated or degenerated, activation of these nociceptors produces deep, paraspinal pain that can refer within the surrounding sclerotome. The spinal cord and nerve roots aren’t the primary sources of facet pain, though nerve roots can be involved in radicular syndromes. The intervertebral disc has its own sclerotomal innervation, but facet pain specifically involves the facet joints, their capsules, and the dorsal ramus innervation.