The joint facets, Located at the back of the vertebrae, they play a fundamental role in the stability and mobility of the spine. These joints are interconnected through the intervertebral disc, vertebral body, and posterior laminae, and their anatomy and function are crucial to understanding flexion, extension, and the structure of the lunar spine, as well as preventing excessive rotation of the vertebrae.

Each facet joint is contained within a capsule and is reinforced by ligaments.. When the body leans back or to the sides, these joints close and compress, providing stability during movement. On the other hand, when leaning forward, the facet joints open and the ligaments stretch, allowing flexion.

The facet joints are vital to avoid rotation or anterior displacement of the vertebrae, and also play a supporting role by carrying approximately 10% of the axial load, while the remaining 80% is supported by the vertebral bodies and intervertebral disc.

He spinal degenerative process It is a physiological phenomenon that usually begins in the second decade of life, specifically in the intervertebral disc. As it progresses, protrusions and herniations occur that cause a decrease in the intervertebral disc. This decrease leads to an increase in pressure on the facet joints, which in turn results in wear of the facet cartilage.

This situation triggers synovitis in the joint and irritation of its capsule, being an underlying cause of facet pain.

Deterioration of the cartilage in the facet joint leads to laxity and subluxation of it, generating hypermobility that gives rise to the formation of osteophytes and sclerosis of the joints, which translates into facet hypertrophy. This instability exceeds physiological limits and is a precursor to low back pain.

In addition to degeneration, certain forced postures, particularly those related to weight manipulation, increase the load supported by the facet joints, accelerating the process of lumbar facet osteoarthritis.

He lumbar facet syndrome, which encompasses inflammation and back pain, can find its origin in facet osteoarthritis. To understand the osteoarthritis process in the facets of the spine, it is essential to take into account the minor nerve branches that innervate the different spinal nerves of each vertebral segment:

• Posterior branch: This innervates the facet joints, the spinous ligaments, the yellow ligament, the lumbar muscles and the skin.
• Sinuvertebral nerve of Luschka: is responsible for innervating the most posterior and lateral area of the annulus fibrosus.

The transmission of pain collected through the posterior branch can manifest as local pain (low back pain) and/or referred pain.

Inflammation or wear of the joint facets activates the nerves that transmit stimuli to the joint, which can trigger the aforementioned discomfort.

Intervention on the posterior branch could block the conduction of painful information from the facet joint.

He The primary symptom of facet osteoarthritis is chronic low back pain. In most cases, this pain manifests itself as a deep and constant discomfort, often being difficult to locate specifically in the lumbar region. This pain radiates to the buttocks, inguinal region, hips or, generally, to the inner extremities.

Patients experience increased discomfort when walking or sitting for long periods, which can lead to the feeling of “not being able to find a pain-free position.” Recurrently, episodes of discomfort may be experienced, accompanied by a decrease in lumbar mobility, which particularly affects lumbar extension and rotation,

Facet osteoarthritis, in some cases, can lead to a spinal canal stenosis Due to the joint deformation and facet hypertrophy. If this stenosis compresses a nervous structure or the spinal cord, the pain radiates through the legs, accompanied by paresthesia, loss of strength and limitation in mobility. In these situations, it may be necessary to stop while driving to experience relief.

He diagnosis of chronic low back pain of facet origin is based mainly on clinical evaluation, imaging studies and the response to facet block.

The characteristics of pain of facet origin They often overlap with those of other causes of low back pain, which can make it difficult to accurately identify these facet arthrodesis-related symptoms. Conventional imaging studies, such as x-rays, CT scans, MRIs or scans, are capable of detecting facet and/or disc degenerative changes, but their precision regarding the facets as the source of chronic low back pain usually present limitations in terms of diagnostic validity. Some specific tests include:

• oblique radiography: allows detailed observation of the facet joint.
• Computed tomography in sagittal section: serves to visualize normal posterior facet joints.
• Computed tomography in axial section- shows normal posterior facet joints without degeneration.

He facet block or lumbar facet block with local anesthetic, it is a fluoroscopy-guided injection procedure. This procedure is not a definitive diagnosis, but it can offer important clues in the diagnostic process.

When a positive response to this technique occurs, the pain tends to decrease or disappear by at least 50%.

He facet osteoarthritis treatment It starts with analgesics or anti-inflammatories, to which muscle relaxants can be added.

Physical rehabilitation, as an essential part of symptomatic treatment, involves re-education of the back through exercise, control of body weight and correction of bad postural habits.

The facet lumbar infiltration with anesthetic and corticosteroid can provide prolonged symptomatic relief and serve as an indication of the potential success of the radiofrequency or rhizolysis surgical technique.

The percutaneous lumbar facet radiofrequency denervation, or rhizolysis, represents a minimally invasive approach to treating chronic low back pain of facet origin. In this spinal microsurgery, the damage to the nerve fibers that transmit pain signals to the facet joints (posterior branch) is controlled through the controlled application of specific heat. A traumatologist specialized in the spine is the professional in charge of carrying out this procedure.

Features and advantages of facet rhizolysis:

• The procedure is performed in an operating room with the aid of fluoroscopy to ensure proper placement of the electrodes near the posterior ramus, between the facet and the transverse process.
• It can be carried out at all lumbar levels, both in cases with unilateral and bilateral facet osteoarthritis.
• It is a percutaneous intervention, does not require skin incisions and generally does not involve hospitalization.
• The patient is required to be awake to collaborate in the identification of pain.
• The electrodes generate heat through radiofrequency, causing a controlled injury in the posterior branch that interrupts the transmission of pain in its area of innervation.
• Although analgesic efficacy may decrease over time, it rarely returns to the level of pain prior to rhizolysis. The technique is safe, allowing it to be repeated if a significant improvement is observed.

Our specialist traumatologists are pioneers in spine microsurgery in Madrid, offering advanced treatments to relieve chronic low back pain of facet origin.

L4-L5 and L5-S1 lumbar arthrodesis is a surgical procedure in which two vertebrae of the lumbar spine are fused, the fourth (L4) and the fifth (L5), or the fifth (L5) and the first sacral vertebra ( S1).

This fusion process aims to stabilize the spine and reduce pain in patients who suffer from conditions such as herniated disc, spondylolisthesis or intervertebral disc degeneration.

While lumbar arthrodesis can be an effective solution that relieves pain in certain cases, it is important to keep in mind that it can also lead to some complications:

• Loss of mobility: Fusion of the vertebrae restricts mobility in the affected area, which may cause the patient to have difficulty bending, turning, or moving normally.
• Change of load on adjacent vertebrae- Fusion of one or more vertebrae can increase load and stress on adjacent vertebrae, which can lead to problems in those areas.
• Possible complications: As with any surgery. Lumbar arthrodesis carries risks of complications, such as infections, bleeding, or problems with the bone graft.

To minimize the risk of complications, it is essential that the surgery be performed by a trusted professional who can guarantee the best possible results.