Clinical report of lumbar facet syndrome complicated with lower limb symptoms without lumbar spinal canal stenosis

Abstract

Introduction: Lumbar facet syndrome is one of the most common diseases that cause low back pain, but it is not uncommon for it to be accompanied by lower limb pain and numbness. We report our experience of treating a patient with lumbar facet syndrome who presented with lower limb symptoms despite no evidence of lumbar spinal canal stenosis on imaging.

Methods: In this study, eight patients with lumbar facet syndrome who had lower limb symptoms and met the following criteria were included: 1) no evidence of lumbar spinal canal stenosis on MRI or myelography, 2) no evidence of myelopathy, and 3) temporary disappearance of not only back pain but also lower limb pain and numbness after facet joint block.

Results: Four patients were male and four were female. The mean age of the patients was 46 years. The affected vertebrae were L4/5 in 5 cases, L5/S1 in 3 cases, and L3/4/5 in 1 case. Lower limb symptoms were unilateral in 6 cases, bilateral in 3 cases, and extending to the lower leg in 7 cases; one patient had only lower limb pain without back pain. We performed posterior medial branch thermocoagulation in all but one patient who recovered conservatively, and posterior lumbar fusion surgery was performed in 3 patients who relapsed.

Conclusions: In the case of patients with lower limb pain and numbness despite no evidence of stenosis in the lumbar spinal canal or intervertebral foramen on imaging, it is important to confirm the pain relief effect of selective facet joint block and to investigate the possibility of referred pain.