What is lumbar facet joint disorder?

The small joints of the lumbar spine are articular synovial joints, the joint capsule is rich in nerve endings, and the synovium within the joint capsule is also rich in myelinated nerve fibers and capillaries. The lumbar small joints are close to the sagittal position, which is favorable to the lumbar spine anterior flexion and posterior extension movement, when more than the range of motion can not be reset, it will be embedded in the synovial membrane and the joint capsule, resulting in lumbar pain, lumbar spine activities are limited and other clinical symptoms, called lumbar small joints disorders. I. Etiology 1. Dislocation of small joints: Commonly due to disc degeneration, narrowing of the intervertebral space, the upper and lower synovial processes can not be properly aligned. Joint capsule and ligament laxity lead to small joint gap in normal activities. 2. Small joint synovial inlay: lumbar spine exerted improperly suddenly appeared severe low back pain, lumbar spine activity is obviously restricted. The reason is that the joint capsule folds, synovial membrane embedded in the joint space, compression of nerve endings. 3. small joint osteoarthritis: chronic strain injury led to small joint osteophytes, hypertrophy, cohesion. Second, the clinical manifestations are mostly seen in middle-aged people, more women than men. There is often a history of chronic lumbar and leg pain with no obvious history of trauma. Sudden severe pain in the lumbar region occurs during normal activities, the site is not clear, lumbar activities are obviously limited, and it is difficult to turn over at night. Physical examination: sacrospinal muscle spasm, deep pressure pain at the small lumbar joints, no neurological signs in the lower limbs, straight leg raising test (-). Third, auxiliary examination 1. X-ray: asymmetry of small joints, increased joint space, overlap, degeneration and hyperplasia can be seen. There may be secondary changes such as scoliosis, loss of lumbar physiological anterior convexity, etc. 2. CT: changes such as articular synostosis, widening of joint space, poor alignment, degeneration of synovial joints, subchondral sclerosis, intra-articular fragmentation of bone, effusion, and pneumatosis are seen. Diagnostic points and differential diagnosis: according to the history, clinical manifestations and typical signs, the diagnosis is not difficult. 1. Intervertebral discogenic pain: degeneration of intervertebral disc can also cause small joint disorder, so it is difficult to differentiate from intervertebral discogenic pain. It is difficult to differentiate it from discogenic pain. The pain disappears quickly and is not easy to recur after repositioning of simple small joint disorder. Discogenic pain is more persistent and difficult to be relieved completely. 2. Lumbar muscle strain: chronic low back pain without acute trauma history. Soreness, swelling and pain, relieved after rest, recurrent. The pressure points are more fixed near the starting and ending points of the muscle. 3. Supraspinatus interspinous ligamentitis: chronic low back pain, limited to the posterior mid-back area. Pressure points are located in the spinous processes and interspinous, not radiating.4. 3rd lumbar transverse syndrome: sacrospinous muscle spasm, pressure pain at the tip of the transverse process of the third lumbar vertebra. Local sealing is effective. 5. Acute lumbar sprain: there is a clear history of trauma, the pressure pain at the muscle attachment point is obvious, and the pain disappears after local sealing. V. Treatment principles 1. bed rest, oral analgesics and antispasmodics. 2. oblique trigger manipulation reset: safe, fast and effective way to relieve severe lumbar pain and muscle spasm. No anesthesia is needed, and the embedded synovial membrane can be relieved of compression by relaxing the lumbar back muscles and rapid rotational reset.3. Acupuncture, massage, physical therapy: it has the effect of promoting blood circulation and relieving pain, but it cannot be cured.4. Local closure: the effect of pain relieving is good for a short period of time.5. Functional exercise of the lumbar back muscles: it enhances lumbar spine stability and prevents recurrence.6. Surgical treatment: the ineffectiveness of conservative treatments and the serious impact on life and workers. Lumbar spine joint capsule and synovectomy is feasible.