Lumbosacral Facet Syndrome

Excerpt

Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice. It is the leading cause of disability in the developed world and accounts for billions of dollars in healthcare costs annually. Although epidemiological studies vary, the incidence of low back pain is estimated to be 5% to 10%, with a lifetime prevalence of 60% to 90%. Most occurrences of low back pain are self-limited and will resolve without intervention beyond brief periods of rest, activity modification, and physical therapy. Approximately 50% of cases will resolve within 1 to 2 weeks. Ninety percent of cases will resolve in 6 to 12 weeks.

Lumbosacral facet syndrome refers to a clinical condition consisting of various patient-reported symptoms, including unilateral or bilateral back pain radiating to either one or both buttocks, sides of the groin, and thighs, stopping above the knee. It should, however, be noted that in some cases, the symptoms of facetogenic pain may mimic radicular symptoms occurring from herniated discs or compressed roots. The facet joint degenerates secondary to repetitive overuse and everyday activities, eventually leading to microinstability and synovial facet cysts that generate and compress the surrounding nerve roots.

The lumbar facet joint constitutes approximately 15 to 45% of low back pain, with degenerative osteoarthritis as the most common form of facet joint pain. History and physical exam may serve useful in the diagnosis of facet joint syndrome, while imaging with radiographs, CT, and MRI are commonly used yet do not show an effective correlation between clinical symptoms and degenerative spine changes. Diagnostic blocks may indicate facet joints as the source of a patient's back pain, with interventions such as intraarticular steroid injection or neurolysis by radiofrequency or cryoablation to treat facetogenic pain.