Trinity Medical Center I Dr. Marin Guentchev, MD, PhD

Lower back pain / Lumbar facet joint pain

ANATOMY OF THE SPINE

The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid. The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus). The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.

DESCRIPTION

Facet joint syndrome (vertebral joint arthrosis) is a chronic pain syndrome originating from the small joints between the vertebrae. The facet syndrome falls into the category of wear-related (degenerative) diseases of the spine. The cause of facet syndrome is most often due to an age-related loss of height of intervertebral discs and associated overload of the facets.
Lower back pain originating from the intervertebral joints is called lubmar facet joint syndrome. Lower back pain is one of the most common causes for people to seek medical advice.

CAUSE OF SYMPTOMS

Gradually progressing inflammation and degeneration in the intervertebral joints in the lumbar spine

SYMPTOMS AND SIGNS

Pain and stiffness in the lower back Leg pain (pseudoradicular type)

THE DIAGNOSIS IS BASED ON

Medical history Clinical exam
Facet joints block
and at least one of the following tests:
Magnetic resonance imaging (MRI) Computer tomography

TREATMENT

The treatment may be non-surgical or surgical.
Non-surgical treatment may include
Physiotherapy Physical exercise
Strengthening the back muscles
Treatment with heat (Fango) Nonsteroidal anti-inflammatory drugs Muscle relaxants Antidepressants

WHEN SHOULD AN OPERATION BE PERFORMED?

At least 2 months of conservative treatment cannot relieve pain significantly

WHAT IS THE GOAL OF SURGERY?

To destroy the nerve endings that carry the pain from the facet joints

HOW IS SURGERY PERFORMED?

Percutaneous radiofrequency thermoablation
Percutaneous cryoablation
Endoscopic radiofrequency thermoablation

WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)?

Tumor of the spine Vertebral fractures Infections and inflammations of the spine
Diseases of the hip or knee
Sacroiliac joint pain Disc herniation Arthritis
Adress
Trinity Medical Center 117 Zaichar St /Ground floor/ /Konstantin Velichkov Metro Station/ BG-1309 Sofia, Bulgaria
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