Lumbar facet syndrome is usually localized dull aching nagging pain in the lower back. Facet joints are small joints in the spine. The human body weight sits on the discs on the front and facet joints in the back of the spine. A chronic degenerative process, athletic or occupational injury and sudden jerk can cause trauma to the facet joint or ligaments around the facet joints
Patient reports usually low back pain radiating in back of the buttock and hamstring muscles. It is usually above the knee joint. In extreme cases, it can radiate below the knee. Patients get worse with twisting or arching backwards in the spine.
A careful history and physical by healthcare professional with physical exam indicates paraspinous tenderness in the spine. Patients report increased pain with right and left tilt of the spine. An imaging study may need to rule out herniated disc or other pathologies of the spine. A procedure called facet joint injection or a nerve block that supplies the facet joint, may determine the source of pain. Facet joint injection is done under fluoroscopy by placing the needle n the joint or by blocking the small nerve next to the spine. A facet syndrome is confirmed if there is significant (50% or more) pain relief following the injections. If patient has no pain relief, the facet is unlikely the source of back pain.
Physical therapy and exercise to reduce the inflammation along with NSAIDS are useful in most of the patients. Exercise builds strength, and mobility. A muscle relaxant may help myofacial spasm. In selective groups of patients, facet injection may be needed with steroids. If facet joint injections do help initially, and do not provide prolonged relief, patient may be a candidate for facet joint rhizotomy. A facet rhizotomy is done by many techniques including by phenol, cryoneurolysis, and by radio frequency thermo coagulation. It is performed under fluoroscopy and it is a safe procedure in the hand of experienced healthcare professional. A needle is placed on small nerves that supply the facet joint. The tip of the needle heats up to disconnect the nerve from the joint so the patient doesn’t feel the pain originating from the joint. There should be no numbness or weakness in the leg or arm after the facet joint rhizotomy. It is a fact that small nerves grow back gradually over several months and some patients do require repeat rhizotomy if their pain does return.