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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.

Questions

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Media Gallery

Dorsal ramus innervation (medial and lateral branches). MAL23 = mamillo-accessory ligament bridging the mamillary and accessory processes of L2 and L3; Z-joint = zygapophyseal joint.
Mamillary process anatomy.

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Author

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

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, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Coauthor(s)

Gary P Chimes, MD, PhD Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute of 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, 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, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, 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

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Lumbosacral Facet Syndrome Follow-up

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