Lumbosacral facet syndrome results from facet joint degeneration due to overuse, resulting in instability and cyst formation. The cysts can compress nearby nerve roots and cause lower back pain that radiates down the leg(s).
Causes include overuse, repetitive movements, trauma, stress and strain to the lower spine, twisting motions, obesity, and intervertebral disk degeneration. There is a strong correlation with age.
The diagnosis begins with a careful history and physical exam. During the physical exam, your physician may have you lean back and rotate sideways. This maneuver increases pressure on the facet joints and can reproduce back pain in those with lumbosacral facet syndrome. While this finding can point to the diagnosis, it does not necessarily mean that lumbosacral facet syndrome is the definite underlying pathology. Diagnostic imaging can help visualize the facet joints and highlight degenerative changes. An MRI is the study of choice in trying to visualize the degenerative changes of lumbosacral facet syndrome. Nerve blocks called medial branch blocks are used to confirm the diagnosis. These are usually performed under radiographic guidance.
Conservative therapy, which resolves symptoms in the majority of patients with lumbosacral facet syndrome, includes non-steroidal anti-inflammatory drugs, Tylenol, and possibly oral steroids. Physical therapy can be beneficial. Weight loss is recommended for overweight patients. Facet cysts can be treated with CT-guided aspiration. However, cysts are prone to recur. Interventional pain management techniques used to treat lumbosacral facet syndrome include facet joint injections and radiofrequency denervation of the medial branch nerves. Surgical management is reserved for cases in which more conservative management is not effective. For intraspinal synovial cysts that are symptomatic, the preferred surgical procedure is a laminectomy with decompression.