TREATMENT OF LUMBAR FACET SYNDROME: ULTRASOUND-GUIDED FACET JOINT BLOCK

TREATMENT OF LUMBAR FACET SYNDROME WITH ULTRASOUND-GUIDED LUMBAR FACET BLOCK
DR. JORDI JIMÉNEZ
 

Low back pain is one of the leading causes of medical consultations and sick leave in our country. It is often multifactorial, originating in different structures: muscular, tendon, disc, or even bone. One of these anatomical structures that cause low back pain is the lumbar facet joint, or lumbar facet, located in the posterior part of the lumbar spine. These lumbar facets are responsible for between 15 and 46% of chronic low back pain in our country, and their involvement by inflammatory, traumatic, or osteoarthritic causes leads to what is known as lumbar facet syndrome.

The main purpose of these lumbar facets is to provide resistance to rotation and anterior displacement in the spine. They are small and support 15% of the body's total axial load. Therefore, these joints are subjected to 10 times the load per cm² that the knees support.

In prolonged extended postures, the facet joints support a greater axial load, and if we add the previous deterioration of the intervertebral disc, this can reach 70% of the total axial load. Prolonged postures, especially in flexion, can also cause overload and irritation of these joints.

Symptoms of lumbar facet syndrome

• Low back pain radiating to the gluteus, hip, or thigh, mimicking sciatic pain
• Lower back stiffness in the morning.

In the case of facet pain without prior structural impairment, there is the so-called acute locked facet syndrome, in which the patient reports becoming "stuck" when performing a simple movement (picking something up from the floor), presenting with lower back pain and marked reduction in mobility.

The diagnosis is clinical, based on the patient's history and physical examination. Other structures capable of producing low back pain (vertebral bodies, intervertebral disc, dura mater, nerve roots, sacroiliac joint, muscles, ligaments, and fascia) can overlap the referred pain pattern of facet origin. For this reason, diagnosing the cause of low back pain is sometimes difficult.

Although initial treatment is symptomatic with local heat, analgesics, and physical therapy, there are chronic cases in which these are not effective, either due to misdiagnosis or concomitant lumbar pathology.

In these cases, ultrasound-guided lumbar facet blocks with anesthetic and corticosteroid offer the possibility of rapid diagnosis and early pain treatment. The anesthetic will block the pain almost immediately, confirming the diagnosis of lumbar facet syndrome. The corticosteroid will treat the inflammation of these facets.

Ultrasound image of the lumbar vertebra: vertebral bone relief in white, lumbar facets in red, yellow arrow: facet block, orange arrow: thermocoagulation (rhizolysis).

En casos crónicos en los que los bloqueos son efectivos, pero mejoran al paciente pocas semanas, se emplea la radiofrecuencia, la conocida rizólisis lumbar. Se trata de la termocoagulación de la rama sensitiva que recoge la información dolorosa de estas articulaciones.

Ambos procedimientos ecoguiados pueden realizarse de forma ambulatoria.

Su duración depende de los niveles a los que se practique, pero no excede los 25-30 minutos.

En los casos crónicos, secundarios en la mayor parte a procesos degenerativos (artrosis), la efectividad inicial puede verse reducida a medio plazo siendo necesario repetir la técnica. En cualquier caso , es una técnica segura que proporciona buenos resultados en cuanto a la mejoría del dolor lumbar de origen facetario.
 

DR. JORDI JIMÉNEZ GENERAL TRAUMATOLOGY SPORTS TRAUMATOLOGY ULTRASOUND-GUIDED THERAPIES

Do you suffer from lumbar facet syndrome? Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma de Mallorca and help you regain your quality of life.