eMedicine Specialties > Sports Medicine > Spine

Lumbosacral Facet Syndrome: Follow-up

Author: Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Coauthor(s): Gary P Chimes, MD, PhD, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Pietro Memmo, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Jul 15, 2008

Follow-up

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Athletes who demonstrate lumbosacral Z-joint pathology should remain out of their sport until they regain full, pain-free range of motion and are able to complete sport-specific training without discomfort. They should also have symmetrical flexibility and be able to maintain trunk control throughout sporting activities to prevent recurrence.

Complications

In some cases, lumbosacral facet syndrome can lead to chronic pain, time lost from employment or sports, and disability. Interventional procedures, such as Z-joint injections with anesthetics and corticosteroids, can lead to transient lower-extremity weakness, insomnia, headache, fluid and electrolyte disorders (especially in patients with congestive heart failure), GI upset, bone demineralization, and impaired glucose tolerance (patients with diabetes). Less common effects are mood swings, increased appetite, and, the most serious, adrenocortical insufficiency. Dural puncture can lead to infection and an increased incidence of headaches.

Prevention

Instruction should be provided to the patient on proper posture, activity modification, and body mechanics in activities of daily living and sports. This helps protect the injured joints, reduce symptoms, and prevent further injury. Positions that cause pain should be avoided.

Prognosis

With an active and focused spine rehabilitation program, the prognosis for these patients to achieve pain-free activity is good; however, the definitive diagnosis of Z-joint pathology is often difficult to make and challenging to confirm. For some patients, LBP may persist, and more aggressive interventions beyond conservative rehabilitation should be considered. Interventions such as medial branch blocks or neurolysis remain controversial, but they should be given consideration in the event conservative treatment remains inadequate and all other sources of LBP have been investigated.

Education

Patient education is important for the recovery and rehabilitation of the spine in patients with lumbosacral facet syndrome. In the acute stage, patients must have a good understanding of their condition and of the possible detrimental effects of prolonged bed rest (ie, >2 d). Instruction in proper posture and body mechanics with activities of daily living is very important for these individuals. As pain becomes more controlled, the patient must be active in a progressive spine rehabilitation program, which later should be incorporated into a home exercise program for continued functional strengthening. Back safety and joint protection strategies should be incorporated throughout the rehabilitation process. 

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Joint Disorders
Resource Center Spinal Disorders

Miscellaneous

Medicolegal Pitfalls

Always obtain informed consent for any interventional procedure. In addition, patients must be informed of the risks, benefits, and potential outcomes associated with any procedure.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Patient Safety
Resource Center Medical Malpractice and Legal Issues
Specialty Site Surgery

Special Concerns

Patients with LBP who demonstrate red flags, such as unexplained weight loss, fever, and chills, should be further evaluated to rule out malignancy or occult infectious processes.

Related Medscape topics:
Resource Center Sepsis
Specialty Site Hematology-Oncology
Specialty Site Infectious Diseases

 


More on Lumbosacral Facet Syndrome

Overview: Lumbosacral Facet Syndrome
Differential Diagnoses & Workup: Lumbosacral Facet Syndrome
Treatment & Medication: Lumbosacral Facet Syndrome
Follow-up: Lumbosacral Facet Syndrome
Multimedia: Lumbosacral Facet Syndrome
References
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Further Reading

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Keywords

lumbosacral facet syndrome, lumbar facet syndrome, back pain, lower back pain, low back pain, LBP, lumbosacral zygapophysial joint syndrome, lumbar zygapophysial joint syndrome, Z-joint pain, lumbosacral zygapophyseal joint syndrome, lumbar zygapophyseal joint syndrome, posterior element pain syndrome, facet joint syndrome, facet joint degeneration, intervertebral disc degeneration, disk degeneration, degenerative disk, degenerative disc, facet syndrome, lumbar nerve root entrapment, facet arthrosis, facet joint pain, facet pain, facet-mediated LBP, facet-mediated low back pain, lumbar spine pain, facet joint dysfunction, low back dysfunction, lower back dysfunction

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Contributor Information and Disclosures

Author

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Gary P Chimes, MD, PhD, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
Gary P Chimes, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pietro Memmo, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Pietro Memmo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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