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J Athl Train 2018 Feb 19;53(2):168-173. Epub 2018 Jan 19.

Cayuga Medical Center, Ithaca, NY.

Objective:   To describe the conservative management of a young athlete with extension-based (EB) low back pain (LBP).

Background:   We present the case of a 15-year-old female high school gymnast with a 4-year history of EB LBP. Magnetic resonance imaging revealed a healed spondylolysis and significant atrophy with fatty infiltrate of the lumbar multifidi muscles (LMM). Read More

Adv Gerontol 2017 ;30(1):84-91

Irkutsk State Medical University, Irkutsk, 664003, Russian Federation;

The aim of the study was to analyze results of using of fasetoplasty method in the treatment of facet-syndrome at lumbar spine in patients with middle and old age groups. The study included 227 patients older than 65 years with degenerative-dystrophic diseases of the lumbosacral spine and the clinical manifestations in the form of a facet syndrome, which in the period from 2010 to 2013 years made fasetoplasty prosthesis of synovial fluid. To assess the clinical effectiveness of using a visual analogue scale of pain (VAS) and a questionnaire for patients with back problems in Oswestry. Read More

Ortop Traumatol Rehabil 2017 Apr;19(2):101-109

Division of Normal and Clinical Anatomy, Centre for Biostructure Research, Warsaw University of Medicine, Warsaw, Poland.

Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Read More

Pain Med 2017 Aug;18(8):1464-1466

Division of Pain Medicine, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Objective: Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space. Read More

J Neurosurg Spine 2016 Mar 20;24(3):402-6. Epub 2015 Nov 20.

Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, United Kingdom.

Surgical correction for kyphoscoliosis is increasingly being performed for patients with mucopolysaccharidosis (MPS). Reported case series have predominantly included patients with Type I (Hurler) and Type IV (Morquio) MPS. To their knowledge, the authors describe the first case report of surgical management of thoracolumbar kyphoscoliosis in Hunter syndrome (MPS Type II) and the rare occurrence of lumbar spondylolisthesis following surgical stabilization. Read More

Clin Neurol Neurosurg 2015 Sep 29;136:29-32. Epub 2015 May 29.

Department of General Neurosurgery, University of Freiburg Medical School, Breisacher Str. 64, D-79106 Freiburg, Germany.

Object: Synovial cysts are generally located in the lumbar spine adjacent to facet joints. Most studies recommend surgical resection. Adhesions of the lumbar synovial cyst to the dura are common and can result in dural tears with subsequent CSF fistula or nerve injury. Read More

Pain Pract 2016 Jan 1;16(1):90-110. Epub 2015 Jun 1.

Department of Anesthesiology, Centre of Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.

Objectives: When conservative therapies such as pain medication or exercise therapy fail, invasive treatment may be indicated for patients with lumbosacral spinal pain. The Dutch Society of Anesthesiologists, in collaboration with the Dutch Orthopedic Association and the Dutch Neurosurgical Society, has taken the initiative to develop the guideline "Spinal low back pain," which describes the evidence regarding diagnostics and invasive treatment of the most common spinal low back pain syndromes, that is, facet joint pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and failed back surgery syndrome.

Methods: The aim of the guideline is to determine which invasive treatment intervention is preferred for each included pain syndrome when conservative treatment has failed. Read More

Zhongguo Gu Shang 2014 Oct;27(10):833-7

Objective: To investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters).

Methods: Since February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. Read More

Eur Spine J 2014 Oct 12;23 Suppl 6:628-33. Epub 2014 Sep 12.

Division of Spinal Surgery, Department of Orthopaedics and Traumatology, Catholic University Hospital, Largo A. Gemelli 8, 00168, Rome, Italy,

Introduction: Aim of the study was to evaluate the effectiveness of facet joints injections in lumbar facet syndrome correlating clinical results to the sagittal contour of the spine.

Methods: Facet joints degree degeneration was evaluated using MRI according to Fujiwara classification. Sagittal contour of the spine was evaluated according to Roussouly classification. Read More

Pain Pract 2014 Jul 2;14(6):e154-8. Epub 2014 May 2.

Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.

Radiofrequency ablation of medial branch nerves is considered a safe and effective treatment for chronic facet joint pain in the cervical, thoracic, and lumbosacral spine. Cooled radiofrequency ablation (C-RFA) is gaining popularity over conventional thermal radiofrequency ablation (RFA) in pain management. However, complications of C-RFA have not been reported in the literature. Read More

Korean J Pain 2013 Oct 2;26(4):368-73. Epub 2013 Oct 2.

Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Background: Bertolotti's syndrome (BS), a form of lumbago in lumbosacral transitional vertebrae, is an important cause of low back pain in young patients. The purpose of this study was to assess the etiology of low back pain and the efficacy of treatment offered to patients with BS.

Methods: All patients of BS Castellvi type1a during a period of 6 months were enrolled in the study. Read More

Acta Orthop Suppl 2013 Feb;84(349):1-35

Department of Orthopaedics, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.

Chronic low back pain (CLBP) is one of the main causes of disability in the western world with a huge economic burden to society. As yet, no specific underlying anatomic cause has been identified for CLBP. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. Read More

Lijec Vjesn 2011 Sep-Oct;133(9-10):330-6

Disorders of lumbosacral (LS) facet joints are manifested by low back pain with or without referred leg pain and decreased mobility of the LS spine (LS facet syndrome). The most frequent causes of LS facet syndrome are functional disorders (functional blockade or dysfunction of facet joint=reversible restriction of facet joint movements caused by meniscoid entrapment) and degenerative changes of facet joints while the others are less frequent (spondyloarthropathies, infection, tuberculosis, synovial cyst, injury). Although it has been proven that the facet joints are one of the most frequent sources of chronic low back pain (15-45%), the fact is that the facet syndrome has been frequently overlooked in patients with chronic low back pain. Read More

Zh Vopr Neirokhir Im N N Burdenko 2011 ;75(2):51-5; discussion 55

Back pain is very widespread and represents a socially significant problem of modern health care. During lifetime 90% of population experiences 1 or more episodes of back pain. This study focuses on assessment of effectiveness of radiofrequency denervation of intervertebral joints in management of patients with low back pain caused by facet pain syndrome. Read More

Asian Spine J 2010 Dec 24;4(2):128-31. Epub 2010 Nov 24.

Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.

This paper reports a rare case of a lumbosacral dislocation associated with symphysis pubis separation and cauda equina syndrome. A 39-year-old male who diagnosed traumatic lumbosacral dislocation underwent an open reduction without fusion. After an open reduction and internal fixation of a symphysis pubis separation, a missed lumbosacral dislocation was diagnosed and an open reduction was performed without fusion. Read More

Prog Urol 2010 Nov 13;20(12):990-4. Epub 2010 Oct 13.

Service d'urologie-andrologie, CHR La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France.

Objective: To review pseudovisceral referred pain and posterior ramus syndrome.

Material And Methods: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (referred pain, low back pain, pelvic pain, abdominal pain) or terms derived from the title or abstract. Read More

Pain Med 2010 Jun;11(6):853-5

Central Alberta Pain & Rehabilitation Institute, Lacombe, Alberta, Canada.

Objective: Describe the clinical presentation, diagnostic evaluation, and successful treatment of a case of symptomatic unilateral lumbosacral junction pseudarticulation using a novel radiofrequency nerve ablation technique.

Case: A 56-year-old female patient who had suffered with low back and right upper buttock pain for 16 years experienced incomplete relief with L4/5 facet joint radiofrequency ablation. She was found to have an elongated right L5 transverse process that articulated with the sacral ala (Bertolotti's syndrome). Read More

Pain Physician 2009 Nov-Dec;12(6):E355-68

Pain Management Center of Paducah, Paducah, KY, USA.

Background: Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, and facet joint pain among other causes. Even though fluoroscopically directed caudal epidural injections and facet joint interventions are effective in some patients, others continue to suffer with chronic persistent pain. Percutaneous adhesiolysis with target delivery of medications has been demonstrated to be effective in these patients. Read More

Arch Orthop Trauma Surg 2010 Sep 24;130(9):1103-10. Epub 2009 Oct 24.

Department of Trauma and Orthopaedic Surgery, University Hospital, University of Mainz, Langenbeckstrasse 1, Mainz, Germany.

Background And Aims: Facet joint denervation is a frequently performed technique to treat facet joint syndrome. Most often this technique is used under fluoroscopic guidance implicating high radiation doses for both patients and surgeons. This prospective study was performed to evaluate the effectiveness in reducing radiation dose during radiofrequency ablation therapy of the lumbar facet joints and to evaluate the feasibility and possibilities of the new real time image guidance system SabreSource. Read More

Vestn Ross Akad Med Nauk 2008 (8):8-12

There is presented an experience of the examination of 517 cases including sportsmen and ballet dancers, 15-45 olds, suffering from low back pain syndrome. 265 patients were diagnosed with osteochondrosis, 105 cases--with spondylolis, 92--with facet syndrome, and 55 cases--with pelvic ligaments ligamentopathia. Based upon the analysis of the results of examination diagnostic algorithm and differential diagnostics of these diseases were developed. Read More

Pain Physician 2001 Apr;4(2):175-80

Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA.

Postlumbar laminectomy syndrome, or pain following operative procedures of the lumbar spine, is increasingly a common entity in modern medicine. Multiple causes proposed for recurrence of pain after lumbar laminectomy are: epidural fibrosis, recurrent disc herniation, instability, and facet joints. Even though the prevalence of persistent low back pain secondary to the involvement of lumbosacral facet joints has been described in controlled studies from 15% to 45%, the prevalence of facet joint mediated pain in postlumbar laminectomy syndrome has not been studied. Read More

Eur Radiol 2007 Feb 30;17(2):523-31. Epub 2006 May 30.

Department of Neuroradiology, San Paolo Hospital, Bari, Italy.

Degenerative-inflammatory lumbar spinal pathology is one of the most common reasons why individuals seek medical care, and low back pain is the main symptom among those most commonly associated with this pathologic condition. Pain is commonly attributed to degenerative disc disease, particularly herniated discs, but many different spinal and perispinal structures may undergo degenerative-inflammatory phenomena and produce pain: discs, bone, facet joints, ligaments and muscles. In particular, in patients with non-radicular low back pain, this syndrome may arise from changes of the posterior elements/perispinal tissues of the lumbar spine (i. Read More

Physiother Theory Pract 2006 Jan;22(1):53-60

Institute of Manual Physical Therapy, Alternative Rehab Inc., Livonia, MI 48152, USA.

This case report describes a 46-year-old female who experienced symptoms of low back pain with pain radiating into the right gluteal area. Initial intervention addressed mechanical dysfunction at the lumbosacral junction. Reduction in symptoms was observed following manual therapy procedures that addressed the lumbosacral junction; however, the right gluteal pain persisted with recurrence of back pain. Read More

J Neurosurg Sci 2005 Dec;49(4):143-6; discussion 146

Department of Neurosurgery, Federal University, Sao Paulo, Brazil.

Aim: Many techniques are used in the back pain treatment, standing out the facet denervation as a therapeutic option for pain that originates in the facet joints. It's known that the facet joint is an abundant area of nocireceptor innervation, although the distribution and the location of the involved branches have not being well demonstrated. A good comprehension about the affected innervation is very important to get an effective treatment. Read More

Berl Munch Tierarztl Wochenschr 2004 Jul-Aug;117(7-8):334-40

Institut für Versuchstierkunde, Medizinischen Fakultät der Rheinisch-Westfälisch Technischen Hochschule Aachen.

We report our results of partial lumbosacral laminectomy for treatment of canine Cauda equina Compression Syndrome due to a lumbosacral stenosis. Opposite to conventional techniques of dorsal laminectomy, only widening of the Spatium interarcuale is performed. This is achieved by exstirpation of the Lig. Read More

Eur J Radiol 2004 May;50(2):134-58

Department of Radiologic Sciences, Downstate Medical Center, State University of New York, Brooklyn 11203, USA.

A review of the imaging features of normal and degenerative anatomy of the spine on medical imaging studies shows features that have been largely overlooked or poorly understood by the imaging community in recent years. The imaging methods reviewed included computed tomography (CT) with multiplanar reconstructions and magnetic resonance imaging (MRI). A routine part of the MRI examination included fat-suppressed T2 weighted fast-spin- or turbo-spin-echo acquisitions. Read More

Di Yi Jun Yi Da Xue Xue Bao 2002 Dec;22(12):1057-60

Department of Orthopedics, Zhujiang Hospital, First Military Medical University, Guangzhou 510282, China.

Nonspecific low back pain has long been a troublesome clinical entity in that the diagnoses are usually hard to define, and the effect of treatment unsure. We have been conducting long-term basic and clinical research in Zhujiang Hospital in an effort to find the exact mechanism for this disease and to explore its causal treatment. On the basis of literature review and treatment result evaluation, we recommend the following approaches for origin-specific diagnosis and treatments: (1) For spinal nerve dorsal ramus syndrome caused by mechanical stimulation on the stem part of the dorsal ramus, freezing the dorsal ramus with liquid-nitrogen may constitute the primary treatment. Read More

Spine (Phila Pa 1976) 2002 Oct;27(19):E428-31

Robert Jones and Agnes Hunt Orthopaedics Hospital, Oswestry, United Kingdom.

Study Design: A case of bilateral symptomatic facet joint synovial cysts arising in association with calcium pyrophosphate deposition disease is reported.

Objective: To present a previously unreported cause for symptomatic synovial cysts of the lumbar spine.

Summary Of Background Data: Synovial cysts of the facet joints occur most commonly in association with degenerative disease of the spine in older individuals. Read More

Spine (Phila Pa 1976) 2001 Jan;26(2):226-9

Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.

Study Design: Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome).

Objectives: To describe the clinical presentation, diagnostic evaluation, and management of facet-related low back pain in a 17-year-old cheerleader and its successful surgical treatment with resection of a contralateral anomalous articulation.

Summary Of Background Data: Lumbosacral transitional vertebrae are common in the general population. Read More

J Am Vet Med Assoc 2000 Sep;217(6):862-4, 844

Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, University of Glasgow, Scotland.

A 7-year-old castrated male Rottweiler was evaluated for an 18-month history of bilateral hind limb lameness, signs of pain on rising, and mild ataxia. A gas-filled lumbosacral disk space (vacuum disk phenomenon) was revealed by use of computed tomography. Additional smaller gas bubbles were in the periphery of the disk and between the degenerated L5-L6 dorsal articular facets (vacuum facet phenomenon). Read More

Radiographics 1998 May-Jun;18(3):621-33

Department of Radiology B, University Hospital, Strasbourg, France.

The lumbosacral spine is the source of pain, suffering, and disability more frequently than any other part of the body. Pain in the lower back can be managed with computed tomography-guided analgesic interventional procedures, such as periradicular infiltration, percutaneous laser disk decompression, facet joint block, and percutaneous vertebroplasty. Periradicular injection of steroids provides short-term and sometimes even long-term relief of low back pain. Read More

Am Fam Physician 1998 Apr;57(8):1825-34, 1839-40

University Hospitals of Cleveland/Case Western Reserve University, Cleveland, Ohio, USA.

Lumbar spine stenosis most commonly affects the middle-aged and elderly population. Entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness and, in severe cases, bowel or bladder disturbances. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication. Read More

Neurosurg Clin N Am 1996 Jan;7(1):119-34

Orthopedic Department, Westfälischen Wilhelms University, Münster, Germany.

Literature has suggested that the facet joint is responsible for at least some low back pain. This article discusses the history, neuroanatomy, pain formation in the joints, definition of facet syndrome, diagnostics, therapy, a review of the literature, and complications of facet coagulation. Read More

Spine (Phila Pa 1976) 1995 Dec;20(24 Suppl):126S-137S

Department of Orthopedic Surgery, University of Wisconsin, Madison, USA.

Study Design: A literature review.

Objectives: To clarify the surgical indications for spinal fusion in the various lumbar conditions.

Summary Of Background Data: This article summarizes the published literature regarding the treatment of lumbar degenerative conditions. Read More

Curr Opin Rheumatol 1995 Mar;7(2):141-6

George Washington University Medical Center, Washington, DC, USA.

Epidemiologic studies document the overuse of surgical procedures in the United States compared with rates in 11 developed countries. Delay in return to work remains an expensive component in the cost of low back pain for workers' compensation claims. Injury to spinal nerve roots may occur secondary to compression with intraradicular edema or from inflammatory phenomena related to phlogistic properties of the nucleus pulposus, independent of nerve compression. Read More

Acta Neurochir (Wien) 1995 ;134(1-2):1-4

Department of Rheumatology and Physical Medicine, Hôspital Régional de Porrentruy, Switzerland.

The authors present preliminary results in a series of 27 patients with a lumbar and/or lumbosacral facet syndrome operated on by use of the soft-system-Stabilization (SSS) according to Graf. Attention is paid to the correct selection of patients for this surgical technique. Excellent, good, satisfactory, moderate, and poor results were obtained in 19 (70%), 2 (7. Read More

Acta Neurochir (Wien) 1994 ;128(1-4):40-6

The authors present their diagnostic and therapeutic protocol as well as the surgical outcome in a series of 119 patients with the lumbar facet syndrome. By use of different surgical techniques such as translaminar screw fixation (n = 56), Louis plate fixation (n = 36), Cotrel-Dubousset instrumentation (n = 11) and soft system stabilization according to Graf (n = 14) excellent, good, satisfactory, moderate and poor results were obtained in 78 (67%), 20 (17%), 14 (12%), 4 (3%), and 1 (1%) instances, respectively. Read More

J Manipulative Physiol Ther 1992 Jan;15(1):36-40

Spinal Research Laboratory, Griffith University, Nathan, Brisbane, Queensland.

Low back pain, with or without pain referred to the leg, affects up to 85% of the population at some time during their lives, which places an enormous economic burden upon many world communities and costs the United States in excess of $13 billion per year. The role of the lumbosacral zygapophyseal (facet, interlamina) joints in the low back "facet" syndrome is briefly discussed, including the clinical symptomatology. The main purpose of this article is to provide preliminary morphological findings of histological studies of human cadaveric lower lumbosacral spines, which show some examples of how the zygapophyseal joints may be involved in dysfunction of mechanical origin. Read More

J Rheumatol 1991 Dec;18(12):1810-2

Department of Medicine, Southern Illinois University School of Medicine, Springfield 62708.

Eighteen patients who were initially diagnosed as having trochanteric bursitis refractory to conventional therapy are reported. The most common causes of pseudotrochanteric bursitis were lumbar radiculopathy (L2, L3), lumbar facet syndrome with pain referred to the lateral thigh, and entrapment neuropathies involving the subcostal, and the lateral cutaneous branches of the iliohypogastric nerves. Less common causes were undisplaced femoral neck fracture, adiposa dolorosa, and hip abductor muscle strain. Read More

Spine (Phila Pa 1976) 1989 Dec;14(12):1373-7

Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, North Carolina.

Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). Read More

Instr Course Lect 1989 ;38:157-65

Degenerative spondylolisthesis is a unique form of spondylolisthesis that is characterized in most patients as a hypertrophic arthritis of the facet joint resulting in segmental instability predominantly in the sagittal plane. Disk degeneration is associated with degenerative spondylolisthesis to a varying degree. Joint involvement may not be uniform in all patients, and a rotary component, although small, is often present. Read More

J Manipulative Physiol Ther 1987 Oct;10(5):253-6

The source of pain in isthmic spondylolisthesis is uncertain. Some authors believe that spondylolysis and/or spondylolisthesis is not a predisposing factor to low back pain and that the mere presence of isthmic spondylolisthesis may, indeed, not be the cause of low back pain in the patient. This study explores a possible source of biomechanical dysfunction as an origin of pain in isthmic spondylolisthesis. Read More

Acta Biomed Ateneo Parmense 1981 ;52(5):205-15

Forty four patients, admitted to the department of of Neurosurgery of the Hospital of Parma, for a recurrence of sciatic pain following discectomy, have been examined between May 1978 and February 1981. In 30 patients myelography was negative for discal hernias, while plain x-ray films and polytomograms of the lumbar spine showed lateral recesses and intervertebral foramina stenosis with roots' compression. The surgical procedures were: medial facetectomy, total facetectomy or hemilaminectomy with removal of pedicle and inferior and superior articular processes, according to the case, obtaining the remission of the pain. Read More

J Neurol Neurosurg Psychiatry 1977 May;40(5):506-10

Twenty-eight patients presenting with low back pain, associated with sciatic or femoral neuropathy, were found to have lateral recess stenosis occurring as a result of hypertrophy of the facet joints, with preservation within normal limits of the sagittal AP diameter of the lumbar canal. Pathology was believed to be traumatic in origin, and the variable nature of the adhesions suggested recurrent inflammation; the hypertrophy of the facet joints may have been the result of traumatic inflammatory hyperaemia. Radiological investigations were unhelpful. Read More