Clinical Features of Patients with Pain Stemming from the Lumbar Zygapophysial Joints

TLDR

Previous studies have reported a wide range of prevalence for zygapophysial joint pain and conflicting results regarding clinical signs. The authors aimed to determine the prevalence and clinical features of lumbar zygapophysial joint pain in patients with chronic low back pain. The study prospectively cross‑sectionally analyzed 176 consecutive chronic low‑back‑pain patients, using screening lignocaine and confirmatory bupivacaine zygapophysial joint blocks. Forty‑seven percent of patients responded to screening injections, yet only 15% achieved ≥50% relief with confirmatory blocks, and no clinical feature predicted response, indicating the zygapophysial joint is a significant pain source but the concept of a distinct facet syndrome is questionable.

Abstract

Study Design This study is a prospective cross-sectional analytic study. Objectives The authors determined the prevalence and clinical features of patients with pain stemming from the lumbar zygapophysial joints. Summary of Background Data Previous studies have demonstrated a wide range of prevalence for zygapophysial joint pain and conflicting results with regard to clinical signs. Methods One hundred and seventy-six consecutive patients with chronic low back pain were investigated with a series of screening zygapophysial joint blocks using lignocaine and confirmatory blocks using bupivacaine. Results Forty-seven percent of patients had a definite or greater response to the screening injection at one or more levels but only 15% had a 50% or greater response to a confirmatory block. Response to zygapophysial joint injection was not associated with any single clinical feature or set of clinical features. Conclusions The zygapophysial joint is an important source of pain but the existence of a "facet syndrome" must be questioned.