Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Pain Pract. 2024 Jan;24(1):160-176. doi: 10.1111/papr.13287. Epub 2023 Aug 28.
Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age.
The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.
There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.
Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
起源于腰椎小关节的疼痛可定义为源自支配关节结构的疼痛：软骨下骨、滑膜、滑膜皱襞和关节囊。在患有机械性腰痛的患者中，报告的患病率从 4.8%到 50%以上不等，其诊断严重依赖于所采用的标准。在设计良好的研究中，患病率通常在 10%到 20%之间，且随年龄增长而增加。
检索并总结了关于腰椎小关节疼痛的诊断和治疗的文献。
腰椎小关节源性疼痛没有特征性的体征或症状。最常见的报告症状是单侧或双侧（在更晚期病例中）轴向腰痛，常呈非皮节分布放射至大腿。大多数患者报告疼痛为酸痛型，活动时加重，有时伴有晨僵。异常放射学发现的诊断价值较差，因为特异性低。SPECT 可准确识别关节炎症，对诊断性腰椎小关节注射具有预测价值。排除“危险信号”后，应考虑保守治疗。对于那些对保守治疗无反应且症状和体格检查提示腰椎小关节疼痛的患者，可以进行诊断/预后性内侧支阻滞，这仍然是选择接受射频消融治疗患者的最可靠方法。
对于源自小关节的慢性腰痛的精选个体，腰椎内侧支射频消融可能有益。
