Lumbosacral Facet Syndrome

Excerpt

Low back pain ranks among the most common musculoskeletal complaints encountered in clinical practice. As the leading cause of disability in the developed world, it contributes to billions of dollars in healthcare expenditures each year. Despite variations across epidemiological studies, the incidence of low back pain ranges from 5% to 10%, with a lifetime prevalence of 60% to 90%. Most episodes resolve without the need for extensive intervention, responding well to brief rest, activity modification, and physical therapy. Approximately 50% of cases improve within 1 to 2 weeks, and up to 90% show resolution within 6 to 12 weeks.

Lumbosacral facet syndrome describes a clinical condition characterized by unilateral or bilateral back pain that may radiate to the buttocks, groin, or thighs, typically stopping above the knee. In certain cases, symptoms of facetogenic pain resemble those of radiculopathy caused by herniated discs or nerve root compression. Repetitive overuse and routine daily activities contribute to degeneration of the facet joints, potentially resulting in microinstability and the formation of synovial facet cysts that compress adjacent nerve roots.

Facet joints contribute to approximately 15% to 45% of low back pain cases, with degenerative osteoarthritis serving as the most prevalent source of facet-related discomfort. A thorough history and physical examination may aid in diagnosing facet joint syndrome. Although radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are frequently employed, imaging findings often fail to correlate reliably with clinical symptoms. Diagnostic blocks can help identify facet joints as the pain generator, while treatment options, eg, intraarticular steroid injections or neurolysis through radiofrequency or cryoablation, offer relief from facetogenic pain.