Back to Basics: Lumbar Facet Joint Pain / Lumbar Spondylosis

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves introduce the topic of pain coming from the lumbar facet joints - specifically when it is related to the general aging and degeneration of the spine (also known as spondylosis). Lumbar facetogenic pain is defined as pain originating from any structure integral to both the function and configuration of the lumbar facet joints including the fibrous capsule, synovial membrane, hyaline cartilage surfaces, and bony articulations. This disease process is common and estimated to account for about 15% of chronic low back pain. The facet joints are part of the 3-joint complex of the spine which includes the intervertebral disc and the paired facet joints. The primary function of the facet joints is a protective role, limiting the movement of the spine in specific planes. Facet joint pathology is typically due to chronic repetitive strain and low grade trauma that accumulates over time and ultimately leads to chronic inflammation of the joint complex as well as peripheral and central sensitization of the involved nerves (which we have discussed in detail in prior talks - see https://anchor.fm/spine/episodes/Back-to-basics-the-Chronification-of-Pain-eon8fq). As with many chronic pain disease processes, the accurate diagnosis of this condition involves a detailed history, careful exam, diagnostic imaging, as well as the utilization of diagnostic image guided procedures. Listen as the doctors discuss the definition, epidemiology, pathophysiology, anatomy, clinical presentation, diagnosis, as well as a brief introduction to the approach to treatment for lumbar facetogenic pain associated with lumbar spondylosis. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007 Mar;106(3):591-614. 2. Cohen SP, Bhaskar A, Bhatia A, et alConsensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working groupRegional Anesthesia & Pain Medicine Published Online First: 03 April 2020.