Lumbar / Pelvis

Lumbar Degenerative Facet Pain

Definition

Lumbar degenerative facet pain, as a cause of lower back pain (LBP), is defined as pain originating from the constituent structures of the lumbar facet joints.

Aetiology

Seventeen to 30% of lower back is due to degeneration of the lumbar facet joints. Age-related degenerative changes of the facet joints, together with trauma, are the main causes of facet joint pain.

Signs and symptoms

The most frequent complaint is unilateral or bilateral paramedian LBP. Medially localised LBP is more related to lumbar discogenic pain.

Sometimes, the pain radiates to the groin, thigh, hip and flank. Pain is provoked by static load, such as prolonged sitting and standing, and sauntering along. Walking and cycling usually work the best.

Diagnostics

Physical Examination

No findings on physical examination are typical for the diagnosis of facet joint pain. Pain provoked by actively- and passively-performed forward and backward lumbar flexion can point in the direction of facet joint pain.

The provocation of pain by passive segmental translation of the lumbar vertebrae (Federung test) in the prone position is considered to be characteristic of facet joint related LPB. However, this is also seen in lumbar discogenic pain. During examination, it is always important to realise that other structures, such as muscles, intervertebral discs and the sacroiliac joint, co-determine the clinical picture.

Additional Somatic Diagnostics

  • In long-standing and progressive LPB, additional imaging techniques must be performed in order to exclude so-called 'red flags', such as malignancies, impression fractures and discitis.
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment