Lumbar facet joint degeneration treatment

• Lumbar Radiofrequency Ablation (LRFA)- Myths and Facts: A Narrative Review of the Literature
• Opioid Dose Reduction Vis-a-Vis Lumbar Medial Branch Intervention
• The effectiveness of fluoroscopically guided lumbar facet steroid joint injections: A systematic review
• Focal fatty infiltration of the lumbar intervertebral disc: a case report and literature review
• The Future of Motion Preservation and Arthroplasty in the Degenerative Lumbar Spine
• Analyses of proximal adjacent segment degeneration and prognostic factors after lumbar fusion surgery: study based on proximal facet joint angle
• Impact of iatrogenic alterations on adjacent segment degeneration after lumbar fusion surgery: a systematic review
• O-Arm Navigated MIS-TLIF Avoids Violation and Delays Degeneration of the Supradjacent Facet Joint

Treatment for lumbar facet joint degeneration (LFJD) focuses on alleviating pain, improving function, and slowing disease progression. Management typically progresses from conservative measures to interventional and surgical approaches, depending on symptom severity and response to earlier treatments.

Conservative Treatments These are often the first-line approaches for managing LFJD.

1. Lifestyle Modifications: Weight Management: Reducing body weight decreases mechanical stress on the lumbar spine. Activity Modification: Avoiding activities that exacerbate pain, such as prolonged standing or repetitive bending.

2. Physical Therapy: Strengthening Exercises: Focus on core stability and lumbar paraspinal muscles to provide spinal support. Flexibility Training: Improve spinal range of motion and reduce stiffness. Posture Correction: Minimize abnormal stresses on facet joints.

3. Pharmacological Therapy: Analgesics: Acetaminophen for mild pain. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Reduce inflammation and pain. Muscle Relaxants: Address muscle spasms associated with LFJD. Topical Agents: Capsaicin cream or topical NSAIDs for localized pain relief. Adjunctive Medications: Antidepressants or anticonvulsants for chronic pain management.

If conservative measures fail, interventional procedures may be considered.

1. Lumbar facet joint nerve blocks: Corticosteroid Injections: Reduce inflammation and provide temporary relief. May include a local anesthetic to assess if the pain originates from the facet joints.

2. Radiofrequency Ablation (RFA): Minimally invasive procedure where radiofrequency energy is used to ablate (destroy) the medial branch nerves supplying the painful facet joints.

Provides longer-lasting relief (6-12 months) compared to steroid injections.

3. Medial Branch Nerve Blocks:

Temporary relief by injecting anesthetic near the medial branch nerves.

Often used diagnostically to confirm facet joint involvement.

Lumbar facet joint degeneration surgical treatment.

These therapies can be used alongside conventional treatments.

Acupuncture: Evidence supports its use for chronic back pain relief.

Chiropractic Care: Manual adjustments may help some patients but should be approached cautiously.

Yoga and Pilates: Focus on improving flexibility, posture, and muscle strength.

Regenerative Medicine:

Stem cell therapy and platelet-rich plasma (PRP) are being explored for their potential to repair cartilage and reduce inflammation.

Neuromodulation:

Spinal cord stimulators or peripheral nerve stimulation are options for refractory chronic pain. Targeted Biologics:

Research into biologic agents targeting inflammatory pathways specific to LFJD is ongoing.

Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain.

Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting.

LA/corticosteroid intra-articular injection

Intraarticular Injection with Autologous Platelet Rich Plasma.

see Lumbar facet joint denervation.