LUMBAR FACET JOINT SYNDROME


Facts:

  1. Accounts for 20-40% of axial low back pain.May occur in absence of x-ray, CT, or MRI findings.Physical examination non-specific and doesn’t make the diagnosis.
  2. May be traumatic or atraumatic.

Symptoms: (see Lumbar Facet Pain Maps)

  1. Central low back pain.
    Pain worse in evenings than in the mornings.
    Pain may radiate into the hip and buttock areas.
    Pain may radiate down the leg though usually not below the knee.
  2. Pain worsened by extension, rotation, and lateral bending.

Diagnosis:

  1. The only reliable method is to perform precision facet nerve blocks (medial branch) under fluoroscopy with local anesthetic. If this relieves the pain for the duration of the local anesthetic, the facet joints are deemed to be pain generators.
  2. The blocks are repeated to insure accuracy.

Treatment:

  1. The joints themselves maybe injected with steroid if they are not too arthritic. This treatment works best in the older population with arthritic facet joints.
  2. Radiofrequency medial branch rhizotomy. Using a 22 gauge needle and a radiofrequency probe, the facet nerves can be located and ablated in a short and relatively painless procedure. This lasts between 3 months and a year, with a mean time of 272 days. The treatment may be repeated.

Lumbar Facet Pain Maps

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