What Is a Facet Joint Injection?

Lumbar facet joint instability refers to those who suffer from lumbar facet joint instability due to trauma degenerative changes and congenital development (also known as facet subluxation or facet dislocation) and cause back pain limitation and other series of symptoms. Synovial membrane incarceration is mostly combined. Bed rest can improve symptoms and can usually be cured.

Basic Information

nickname: Facet subluxation or facet dislocation
Visiting department: orthopedics
Multiple groups: Young adults
Common locations: Lumbar facet joint

Common causes: Those who suffer from lumbar facet joint instability due to trauma degenerative changes and congenital development, and have limited back pain and other symptoms
Common symptoms: Low back pain, nerve root irritation symptoms, lower limb pain, disappearance of waist physiological curvature, throbbing pain and tenderness, etc.

Causes of lumbar facet joint instability

When the lumbar spine is subjected to excessive vertical load stress or shearing of the lumbar spine, the small joints are prone to trauma synovitis leading to malnutrition of the articular surface cartilage, cracks on the cartilage surface and cracks on the articular surface. Bone cancellous also undergoes degenerative changes and the bone becomes hard. The joint capsule can tear after being subjected to overload stress or severe rotational stress, and fibrous scarring can occur. When the intervertebral disc degeneration narrows the intervertebral space, it can lead to subluxation of the facet joints.

Clinical manifestations of lumbar facet joint instability

Back pain

Patients are mostly young adults. During an acute attack, most patients immediately suffer from unilateral or bilateral lower back pain during the process of twisting or bending to become extended, and the pain of the active waist worsens, even radiating to the buttocks, thighs, and crotch. Generally does not involve the calf. Patients are often in a forced position, afraid of being touched or moved by others.

2. Nerve root stimulation symptoms

There may be symptoms of nerve root stimulation at the early stage, and lower limb pain may occur. Generally, the scope involved is slightly smaller, and it does not spread according to the nerve root distribution area.

3. Signs

During the acute attack, the physiological curvature of the waist disappeared, and the affected facet joints had obvious throbbing pain and tenderness. The local closure of the affected vertebral facet joints with procaine or lidocaine could reduce the pain. Leg muscle strength and sensation were normal.

Lumbar facet joint instability test

X-ray examination shows changes in the physiological curvature of the lumbar spine, and it is generally not easy to find facet joint displacement. However, dynamic lateral radiographs can show signs of looseness, and it can be found that the bilateral articular processes are asymmetric. Left and right oblique positions sometimes see joints embedded in the isthmus. CT and MRI images can show the profile of bone mass and surrounding soft tissue of the affected vertebral segment.

Diagnosis of lumbar facet joint instability

Clinical symptoms and signs

Seen in young and middle-aged people, it often occurs in the process of sudden twisting or changing from bending to stretching. Presented as severe pain, waist activity was significantly restricted, sacroiliac muscles were significantly tense, and stiff waist had tenderness and throbbing pain.

2. Closed therapy

Inject 1% procaine into the diseased small joints, and the symptoms alleviate or disappear after a few minutes, which is helpful for the diagnosis of the disease.

3. Imaging

X-ray examination showed changes in the physiological curvature of the lumbar spine. Facet displacement is generally not easy to find. However, dynamic lateral radiographs can show signs of looseness, and it can be found that the bilateral articular processes are asymmetric. Left and right oblique positions sometimes see joints embedded in the isthmus. CT and MRI images can show the profile of bone mass and surrounding soft tissue of the affected vertebral segment.

Treatment of lumbar facet joint instability

Conservative treatment

(1) Manual operation Manual reduction is an effective measure for the treatment of lumbar facet joint dislocation. Commonly used methods include oblique pull back and rotation reduction, etc. It is advisable to massage the affected part of the lower back before manual reduction.

(2) Pelvic traction The patients with severe lumbar spasm who refuse to perform manual reduction can first seal the affected vertebral joints, and then perform pelvic traction after the pain is relieved.

(3) Physical therapy Physical therapy such as hot compresses and ultra-short wave spectrum analyzers can be applied to relax muscles, reduce edema and improve local blood circulation.

(4) Drugs When low back pain is obvious, anti-inflammatory, analgesic and antispasmodic drugs can be taken orally, such as ibuprofen, acetaminophen / isoproterin / caffeine (sanlitong), indomethacin (indomethacin), etc. .

(5) Small joints can be closed with 1% procaine or 2% lidocaine, adding beclomethasone suspension or suspension of acetate-prednisolone (prednisolone), using a 7th lumbar puncture needle or heart An internal injection needle infiltrates the facet joint at the tender point of the facet joint 1.5 cm next to the spinous process. Lumbar 4-5 and lumbar 5- 1 facet joints are generally selected for multiple injections.

2. Surgical treatment

For cases where treatment is ineffective and low back pain seriously affects daily life. Can be treated with surgery. Treatment options include: fixed fusion and unstable segmental dynamic reconstruction. Fusion technology can be selected from posterolateral fusion technology, interlaminar fusion technology, and intervertebral fusion technology. Fixed integration can be achieved through traditional open approaches, or through minimally invasive approaches.