Denver Lumbar Facet Syndrome Specialists

What is it

Lumbar facet syndrome is low back pain emanating from the facets, also called zygapophyseal joints. These are synovial joints with an articular surface, synovial membrane and fibrous capsule connecting adjacent vertebral levels. They articulate and facilitate truncal movements. Furthermore, each facet joint receives innervation from 2 medial branch nerves, which are branches off the dorsal root of the spinal nerve. Facet arthrosis can develop over time as normal wear and tear but is increased with activity which puts stress on these joints. Other associated causes include systemic inflammatory arthritis, synovial cysts, and microtrauma. It has been reported that the presence of lumbar facet syndrome in patients with chronic low back pain can range from 15%-45%, increasing in prevalence with age. 

Diagnosis

Typical features include unilateral or bilateral low back pain which can be referred to the groin, hips, or thighs. Pain infrequently radiates below the knees. It is exacerbated by twisting, back, extension, and prolonged standing and can be relieved with supported flexion or rest. Patients often have tenderness along the facet joints in the low back. Although no imaging findings reliably predicts the facet joints a source of pain, often patients will have lumbar spondylosis and facet arthrosis noted on lumbar XRs and/or MRI. Diagnostic nerve blocks can also be very helpful in the diagnosis. 

Treatment

If lumbar facet syndrome is suspected and patients have not responded to typical conservative treatments such as NSAIDS and physical therapy, either facet joint injections or medical branch blocks can provide both diagnostic and therapeutic relief. Furthermore, if the patient responds to diagnostic medial branch injections, lumbar facet radiofrequency ablation is a common interventional option that can provide from 6 months to greater than 1 year of relief.

References:

Benzon HT et al. 2014. Practical Management  of Pain. 5th Edition. Elsevier. Philadelphia, PA. 

Romain P et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018 Oct;9(5): 773-789.