Facet syndrome. Minimally invasive surgical treatment. (Clinical case with a literature re-view).

The problem of the pathology of the facet joints of the lumbar spine remains significant and is medical and social due to persistent pain syndrome, high incidence of morbidity and frequent disability outcomes. The complex anatomical and topographic relationships of the facet joints, intervertebral discs and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. A pair of facet joints and an intervertebral disc constitute a functional unit - a "three-component complex" and are interconnected with each other. The article examines the anatomical and morphological features and radiological classifications of degenerative changes in the facet joints, which are currently used in clinical practice. Facet joint pathologies are the most common nosological form of degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and the formation of chronic pain syndrome. The features of facet syndrome diagnostics are presented on a clinical example of surgical treatment by means of laser dereception of facet joints.

SPECIFICS OF THERAPY FOR BACK PAIN IN PATIENTS WITH FACET SYNDROME

Back and neck pain are among the most common medical complaints in developed countries, with up to 66% of the population suffering from acute nonspecific back pain. As early as 1911, Goldthwaite J.E. proved that the articular joints of the spine can serve as a source of pain impulsation, with the proportion of facet syndrome increasing in older age groups, which can cause a clinical dilemma in identifying causes of back pain in the elderly. Like other synovial joints, the bicuspid joints, which are richly innervated by nociceptors, are also at risk of developing dystrophic changes with destruction of articular cartilage and, accordingly, the development of pain, which is provoked by stretching of the bicuspid joint capsule against the background of inflammatory modulators activation. Aim. The aim of the study was to investigate the efficacy of different methods of treatment of facet syndrome. Material and methods. An analytical review of publications in the scientific medical literature was performed. Results and discussion. In facetsyndrome, both local injection therapy with glucocorticosteroids, hyaluronic acid, local anesthetics, mesenchymal stem cells, and platelet-derived autoplasma are effective. Additional application of non-pharmacological treatments such as therapeutic gymnastics, physiotherapy, and therapeutic massage potentiates the effects of conventional conservative therapy. Radiofrequency laser neurotomy has been recognized as an alternative effective treatment for facet syndrome with a long-term positive effect. The choice of drugs and cellular substances for therapeutic blocks is wide enough and provides an adequate therapeutic approach to the treatment of nonspecific back pain caused by articular joint lesions. Conclusion. The diagnosis of facet syndrome is a diagnosis of exclusion, which requires a thorough differential diagnosis to choose further adequate treatment strategy.

Clinical Diagnosis Scale for Lumbar Pain of Facet Origin: Systematic Review of Literature and Pilot Study

INTRODUCTION Lumbar pain affects between 60–90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. METHODS The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature, Phase 2, a list of signs and symptoms, phase 3, submitted to a committee of experts to discriminate the most significant signs and symptoms, Phase 4, recollection of patients and the evaluation questionnaire was applied, phase 5, selective facet block and subsequent postoperative clinical control, phase 6, propose a clinical scale of diagnosis scale RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms and 3 signs. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. Few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.

Predicting Treatment Success with Facet Syndrome: An Algorithm to Predict Lumbar Radiofrequency Ablation Responders in a Military Population

Objective Radiofrequency ablation (RFA) of the medial branch nerve is a commonly performed procedure for patients with facet syndrome. RFA has previously been demonstrated to provide long-term functional improvement in approximately 50% of patients, including those who had significant pain relief after diagnostic medial branch block. We sought to identify factors associated with success of RFA for facet pain. Design Active-duty military patients who underwent lumbar RFA (L3, L4, and L5 levels) over a 3-year period were analyzed. Defense and Veterans Pain Rating Scale (DVPRS) and Oswestry Disability Index (ODI) scores were assessed the day of procedure and at the 2-month and 6-month follow-up. These data were analyzed to identify associations between patient demographics, pain, and functional status and patients’ improvement after RFA, with a primary outcome of ODI improvement and a secondary outcome of pain reduction. Results Higher levels of starting functional impairment (starting ODI scores of 42.9 vs. 37.5; P = 0.0304) were associated with a greater likelihood of improvement in functional status 6 months after RFA, and higher starting pain scores (DVPRS pain scores of 6.1 vs. 5.1; P < 0.0001) were associated with a higher likelihood that pain scores would improve 6 months after RFA. A multivariate logistic regression was then used to develop a scoring system to predict improvement after RFA. The scoring system generated a C-statistic of 0.764, with starting ODI, pain scores, and both gender and smoking history as independent variables. Conclusions This algorithm compares favorably to that of diagnostic medial branch block in terms of prediction accuracy (C-statistic of 0.764 vs. 0.57), suggesting that its use may improve patient selection in patients who undergo RFA for facet syndrome.

Minimally invasive interventional approaches for treatment of facet joint syndrome

The facet syndrome is a unilateral or bilateral pain originating from the intervertebral joint. Its frequency reaches 30% of the population of patients with low back pain. Inflammation plays a significant role in cartilage degeneration and the development of osteoarthritis, and also significantly contributes to swelling with overstretching of the joint capsule and irritation of nociceptive receptors. Minimally invasive interventional approaches play a significant role in the treatment of facet syndrome. This review systemize the ways to treat the pain through corticosteroid infiltrations and interventional denervations of the intervertebral joint, which may be complementary techniques. The literature is analyzed and our experience is presented.

Assessment of outcomes after surgical treatment of an isolated facet-syndrome in the cervical spine using facet joint laser denervation

Chronic pain in the cervical spine is one of the relevant problems of modern vertebrology. This is due to the polyetiological formation of clinical symptoms and to the variety of surgical techniques, which are often used without taking into account the leading pathomorphological substrate of clinical symptoms. Purpose: To analyze clinical results of surgical treatment of an isolated facet-syndrome of the cervical spine using laser denervation of facet joints (FJ).Material and methods. The study included 234 patients aged in average 58 (53; 67). After provocative tests, an isolated facet-syndrome was diagnosed in them. FJ laser denervation was performed in 2013–2016. A visual analogue pain scale (VAS), neck disability index (NDI), Macnab subjective satisfaction scale and complications were used for analyzing treatment efficacy. The follow-up dynamic observation lasted for 36 months, in average, after the surgery. Results. It has been found out that the technique of laser denervation of cervical FJ is highly effective for treating patients with an isolated facet-syndrome caused by FJ degenerative diseases. Clinical efficacy is supported by a persistent positive dynamics in terms of pain syndrome and functional status at early and late postoperative periods with low risks of perioperative complications.