From the Guidelines
Treatment for early lower lumbar facet osteoarthropathy should begin with conservative measures, including non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy, as these methods have been shown to be effective in reducing inflammation and pain 1. The impression indicates early lower lumbar facet osteoarthropathy, which is degenerative arthritis affecting the facet joints in the lower part of the lumbar spine.
Key Considerations
- Conservative therapy with both pharmacologic and nonpharmacologic methods is the first-line treatment for chronic low back pain 1.
- Patients presenting with subacute or chronic low back pain, with or without radiculopathy, who have failed 6 weeks of conservative therapy should be imaged if they are believed to be candidates for surgery or intervention or if diagnostic uncertainty remains 1.
- MRI of the lumbar spine has become the initial imaging modality of choice in these patients, as it has excellent soft-tissue contrast and accurately depicts lumbar pathology 1.
Treatment Recommendations
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily with food or naproxen 500mg twice daily for 1-2 weeks can help reduce inflammation and pain.
- Physical therapy focusing on core strengthening and lumbar stabilization exercises should be initiated, with sessions 2-3 times weekly for 4-6 weeks.
- Application of heat for 15-20 minutes several times daily can help relieve muscle spasm.
- Activity modification to avoid positions that aggravate pain is recommended, though maintaining general activity within pain limits is important.
- If these measures fail to provide adequate relief, consider facet joint injections with corticosteroids.
- Weight loss is advised for overweight patients to reduce mechanical stress on the facet joints.
Rationale
The goal of treatment is to reduce pain and inflammation, improve function, and prevent further degeneration of the facet joints. Conservative measures, including NSAIDs and physical therapy, are effective in achieving these goals and should be the first line of treatment 1. Imaging studies, such as MRI, may be necessary to confirm the diagnosis and rule out other potential causes of low back pain 1.
From the Research
Diagnosis and Management of Facet Joint Osteoarthropathy
- The diagnosis of facet joint osteoarthropathy can be challenging, but imaging studies such as fluoroscopy or computed tomography (CT) guidance can be helpful in identifying the affected joints 2.
- Physical examination and clinical assessment can also be useful in selecting patients for facet joint nerve blocks, with a level of evidence II and strong strength of recommendation 2.
- The level of evidence for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs is IV, with weak strength of recommendation 2.
Treatment Options for Facet Joint Osteoarthropathy
- Intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation are two treatment options for facet joint osteoarthropathy, with similar improvements in pain relief and functional improvement 3.
- Medial branch blocks (MBB) and facet joint injections (FJI) can also be employed for chronic low back pain, with different compounds such as corticosteroids, hyaluronic acid, sarapin, and local anesthetics 4.
- Radiofrequency ablation (RFA) is a preferred method for denervation of the facet joint when routine steroid treatment is not effective 5.
Efficacy of Treatment Options
- Steroid injections can promote a reduction of numeric rating scale (NRS) by 28% and an improvement of the Oswestry Disability Index (ODI) by 13.2% 4.
- Local anesthetics can produce an improvement of the ODI by 9.8% 4.
- Sarapin can result in a reduction of NRS by 44% and an improvement of the ODI by 14.9% 4.
- Radiofrequency denervation can provide favorable short- and midterm results in terms of pain relief and function improvement 3.