Lumbosacral Facet Syndrome Follow-up

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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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.

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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.

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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.

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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.

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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.

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