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Актуальність. Висока поширеність дегенеративно-дистрофічного ураження хребта при малій ефективності терапії спондилоартрозу робить актуальним дослідження щодо лікування нижньопоперекового болю, зумовленого переважно спондилоартрозом, інноваційним міні-інвазивним методом високочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів. Мета дослідження: визначити ефективність впливу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевих анестетиків і стероїдних препаратів з урахуванням ранніх та віддалених результатів лікування на ліквідацію больового синдрому у хворих із нижньопоперековим больовим синдромом, в яких переважали прояви спондилоартрозу. Матеріали та методи. Проведений аналіз ранніх та віддалених результатів лікування 78 пацієнтів (37 чоловіків та 41 жінка віком від 51 до 79 років) із нижньопоперековим больовим синдромом, в яких провідним клінічним проявом був артроз дуговідросткових суглобів, які становили основну групу, та проведена радіочастотна денервація фасеточних суглобів (за допомогою апарата RFG-1A/RFG-1B фірми Radionics) у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату. Оцінка больового синдрому проводилася чотири рази — у доопераційному, післяопераційному періодах (протягом тижня), через три місяці та через один рік після лікування. Використовувалася візуальна аналогова шкала болю та опитувальник індексу непрацездатності Освестрі. Контрольну групу становили 136 пацієнтів (73 чоловіки та 63 жінки віком від 44 до 81 року) із нижньопоперековим болем із домінуванням проявів спондилоартрозу, які лікувались виключно за допомогою методу радіочастотної денервації фасеточних суглобів. Результати. Як відразу ж після проведеного лікування, так і через три місяці після його здійснення отриманий вірогідний результат лікування хронічного нижньопоперекового больового синдрому, зумовленого переважно ураженням дуговідросткових суглобів, як в основній, так і контрольній групах, що свідчить про ефективність обох методів лікування. Разом із тим відмічається чітка вірогідна різниця між основною та контрольною групами як відразу після проведеного лікування, так і через три місяці після його здійснення, що свідчить про вірогідну вищу ефективність методу радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату в ранньому післяопераційному періоді. У віддаленому періоді (через 1 рік після лікування) отриманий вірогідний результат лікування як в основній так і в контрольній групах, але відмінність у результатах лікування між цими групами відсутня. Висновки. Отримані результати в ранньому та віддаленому періодах після лікування свідчать про ефективність та безпечність як радіочастотної денервації фасеточних суглобів, так і радіочастотної денервації фасеточних суглобів у поєднанні з періартикулярним введенням місцевого анестетика та стероїдного препарату у хворих із нижньопоперековим больовим синдромом, де домінують прояви спондилоартрозу. Вірогідно кращі результати в ранньому періоді отримані в групі пацієнтів, яким проводилось поєднання радіочастотної денервації фасеточних суглобів із періартикулярним введенням місцевого анестетика та стероїдного препарату. Тоді як у віддаленому періоді (через 1 рік після лікування) така відмінність між основною та контрольною групами відсутня. Періартикулярне введення місцевих анестетиків та стероїдів ефективне в короткотерміновій перспективі, а радіочастотна денервація фасеточних суглобів ефективна як у короткотерміновій, так і в довготерміновій перспективі. Обидві методики можуть бути рекомендовані до включення в алгоритм лікування фасеточного синдрому при неефективності консервативного лікування.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Back and neck pain are among the most common medical complaints in developed countries, with up to 66% of the population suffering from acute nonspecific back pain. As early as 1911, Goldthwaite J.E. proved that the articular joints of the spine can serve as a source of pain impulsation, with the proportion of facet syndrome increasing in older age groups, which can cause a clinical dilemma in identifying causes of back pain in the elderly. Like other synovial joints, the bicuspid joints, which are richly innervated by nociceptors, are also at risk of developing dystrophic changes with destruction of articular cartilage and, accordingly, the development of pain, which is provoked by stretching of the bicuspid joint capsule against the background of inflammatory modulators activation. Aim. The aim of the study was to investigate the efficacy of different methods of treatment of facet syndrome. Material and methods. An analytical review of publications in the scientific medical literature was performed. Results and discussion. In facetsyndrome, both local injection therapy with glucocorticosteroids, hyaluronic acid, local anesthetics, mesenchymal stem cells, and platelet-derived autoplasma are effective. Additional application of non-pharmacological treatments such as therapeutic gymnastics, physiotherapy, and therapeutic massage potentiates the effects of conventional conservative therapy. Radiofrequency laser neurotomy has been recognized as an alternative effective treatment for facet syndrome with a long-term positive effect. The choice of drugs and cellular substances for therapeutic blocks is wide enough and provides an adequate therapeutic approach to the treatment of nonspecific back pain caused by articular joint lesions. Conclusion. The diagnosis of facet syndrome is a diagnosis of exclusion, which requires a thorough differential diagnosis to choose further adequate treatment strategy.

Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5–S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.

Chronic pain in the cervical spine is one of the relevant problems of modern vertebrology. This is due to the polyetiological formation of clinical symptoms and to the variety of surgical techniques, which are often used without taking into account the leading pathomorphological substrate of clinical symptoms. Purpose: To analyze clinical results of surgical treatment of an isolated facet-syndrome of the cervical spine using laser denervation of facet joints (FJ).Material and methods. The study included 234 patients aged in average 58 (53; 67). After provocative tests, an isolated facet-syndrome was diagnosed in them. FJ laser denervation was performed in 2013–2016. A visual analogue pain scale (VAS), neck disability index (NDI), Macnab subjective satisfaction scale and complications were used for analyzing treatment efficacy. The follow-up dynamic observation lasted for 36 months, in average, after the surgery. Results. It has been found out that the technique of laser denervation of cervical FJ is highly effective for treating patients with an isolated facet-syndrome caused by FJ degenerative diseases. Clinical efficacy is supported by a persistent positive dynamics in terms of pain syndrome and functional status at early and late postoperative periods with low risks of perioperative complications.

Standard treatment for lower back pain (LBP) includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Objective : to determine the magnitude of the effect of injectable chondroitin sulfate (CS) as part of combination therapy for LBP on the intensity of pain syndrome. Patients and methods . The investigation was conducted in August 2019 to February 2020. A total of 60 patients (23 men and 37 women) aged 36 to 66 years (mean age, 48.65±8.72 years) with non-specific LBP were followed up. The patients were divided into two equal groups. A study group (n=30) took a NSAID (meloxicam) 7.5 mg twice daily for 7—10 days and intramuscular (i.m.) CS every other day in accordance with the scheme: the first three injections at a dose of 1 ml (100 mg) on days 1, 3, and 5; if this was well tolerable, a dose of 2 ml (200 mg) from the 4th injection (on day 7). A control group (n=30) used meloxicam 7.5 mg twice daily for 7—10 days. Changes in the patients' status were evaluated at baseline and 10, 20, and 50 days after therapy. The authors used a numerical rating scale (NRS) to determine the intensity of pain (at rest, during walking, during palpation), as well as the Oswestry functional status scale (OFSS). Adverse events (AEs) were evaluated. Results and discussion . In the study group, there was a decreased need for NSAIDs on day 7 of therapy, whereas in the control group, there were no dosage regimen changes through the treatment cycle. The intensity of pain syndrome according to the NRS decreased by 89.8% in the study group and by 68.3% in the control group; that according to OFSS reduced by 95.5% in the study group and by 86.6% in the control group (p

Background Facet syndrome is defined as pain that arises from any structure of the facet joints, including the fibrous capsule, synovial membrane, hyaline cartilage, and bone. Objectives To compare the effectiveness of US-guided and blind injections on clinical outcome in facet syndrome. Materials and methods Forty-seven patients with the diagnosis of facet syndrome were included. Patients were consecutively randomized into one of the two groups. The patient's history, physical examination and routine laboratory parameters were obtained and diagnose was established based on physical findings. Two injections (mixture of 2 ml of 1% lidocaine hydrochloride and 20 mg of triamcinolone, to a single or maximum two sites depending on the clinical characteristics of the facet joint) were performed with 15 days apart, as blinded or US-guided manner. Clinical outcome assessments were carried out at 0, 2nd and 6th weeks, using Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and State-Trait Anxiety Inventory (STAI). Results The patients' initial VAS and ODI were not significantly different. When the two groups were compared in the 6th week in terms of VAS scores, improvement was more pronounced in the US-guided injection group (US-guided group (n= 23) before 7.6 (2.2) cm, after 3.0 (1.7) cm, P= 0.0001 vs blind group (n= 24) before 7.2 (1.3) cm, after 5.2 (2.0) cm, P= 0.0001). The improvement in initial and 6th week ODI was statistically significant in the US-guided injection group (P= 0.006). Except STAI I for US-group, trait anxiety scale scores were significant in both groups. Conclusion The US-guided local injections offer better clinical outcome in the treatment of facet syndrome.

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

In today ‘s world, back pain is a heavy burden and leads to a decrease in the working capacity, quality of life of people. The choice of tactics of treatment of pain in a back is defined by the pain reason: nonspecific pain, the specific pain caused by serious diseases or a compression of a root. The most frequent cause of back pain is nonspecific pain due to myofascial, muscular-tonic syndrome, facet syndrome, and sacral-iliac joint dysfunction in lower back pain. The article presents clinical symptoms of these syndrome, as well as techniques of neuroorthopedic examination, which allow to detect one or more abrasions of back pain. To prevent acute non-specific pain, it is recommended to prescribe non-steroidal anti-inflammatory drugs (NSAID) and muscle relaxants. Along with pharmacological treatments, treatment of patients with back pain should be more comprehensive and include cognitive-behavioral therapy and kinesiotherapy. Determination of the source of back pain in neuroorthopedic examination makes it possible to carry out local therapy in stages using blockages with local anesthetics and glucocorticoids. In case of insufficient effectiveness of blockades, it is possible to carry out radiofrequency denervation of facet joints or sacral-iliac). Clinical and neuroorthopedic examination of a patient with back pain with identification of sources of pain, analysis of the causes that led to its development, adequate treatment and recommendations to prevent repeated exacerbations can significantly reduce the risk of chronization of back pain and improve the quality of life of patients.

8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.

RESUMEN Objetivo: En la lumbalgia mecánica por síndrome facetario lumbar están indicadas como opciones terapéuticas los bloqueos periarticulares e intrarticulares de las articulaciones facetarias lumbares, así como el bloqueo nervioso del ramo medial de la raíz o ramo posterior del nervio raquídeo. El bloqueo nervioso del ramo medial puede llevarse a cabo mediante control ecográfico o radioscópico. El objetivo de este estudio es valorar si existen diferencias en la eficacia analgésica del bloqueo en función de la técnica de imagen con la que se lleva a cabo (ecografía frente a radioscopia-fluoroscopia). Pacientes y método: Se ha realizado un estudio clínico transversal durante el mes de noviembre de 2020, analizando los bloqueos facetarios realizados en la Unidad del Dolor del Hospital Universitario Clínico de Salamanca entre mayo de 2018 y septiembre de 2020. La muestra analizada cuenta con 315 pacientes, de los cuales 212 fueron sometidos a bloqueo facetario ecoguiado en consulta y 103 se realizaron bajo control radioscópico en el quirófano. Se ha evaluado la medida del dolor inicial, previo al bloqueo, mediante la escala analógica visual (EVA inicial), así como la EVA final y el porcentaje de mejoría subjetiva recogido en los 15 días posteriores a la realización de la intervención, valorando sus diferencias en función de la técnica de imagen empleada para su realización. Resultados: Los valores de EVA final de los pacientes que se realizaron el bloqueo mediante radioscopia y la de aquellos que lo realizaron ecoguiado fue similar, con un resultado final de 3,5 (mediana), así como el porcentaje de mejoría subjetiva que también fue similar en ambos grupos, alcanzando esta el 50 %. Conclusiones: No existen diferencias en la eficacia analgésica del bloqueo facetario lumbar en función de la técnica de imagen empleada para su realización: radioscopia-fluoroscopia o ecografía. ABSTRACT Objective: In mechanical low back pain due to lumbar facet syndrome, periarticular and intra-articular blocks of the lumbar facet joints as well as nerve blocks of the medial branch of the spinal nerve root or posterior branch of the spinal nerve are indicated as therapeutic options. The nerve block of the medial branch can be performed by ultrasound or radioscopic monitoring. The aim of this study is to assess whether there are differences in the analgesic efficacy of the block depending on the imaging technique used (ultrasound versus fluoroscopic-radioscopy). Patients and method: A cross-sectional clinical study was conducted during the month of November 2020, analysing the facet blocks performed in the Pain Unit of the Hospital Universitario Clínico de Salamanca between May 2018 and September 2020. The sample analysed consisted of 315 patients, of whom 212 underwent an echo-guided facet block in consultation and 103 were performed under radioscopic control in the operating theatre. The initial pain measurement, prior to the block, was evaluated using the visual analogue scale (initial VAS), as well as the final VAS and the percentage of subjective improvement recorded 15 days after the intervention, assessing the differences according to the imaging technique used for its performance. Results: The final VAS values of the patients who underwent radioscopic block and those who underwent echo-guided block were similar, with a final result of 3.5 (median), as was the percentage of subjective improvement, which was also similar in both groups, reaching 50 %. Conclusions: There are no differences in the analgesic efficacy of the lumbar facet block depending on the imaging technique used for its performance: fluoroscopy-radioscopy or ultrasound.

The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

Aim Radiofrequency thermocoagulation (RFT) at various temperatures and durations will be evaluated in this study to treat low back pain caused by facet joints. Material and methods This is a randomized controlled, double-blind study. Patients diagnosed with facet syndrome were randomly divided into three groups. RFT was applied to the medial branches, which received senses from the facet joint 90oC 50 seconds in 31 patients, 85oC 60 seconds in 32 patients, 70oC 90 seconds in 33 patients at constant current and impedance values. Numeric Rating Scale (NRS) scores before and after the treatment (1 and 6 months), the need for additional analgesics after treatment, and opioid dose changes were recorded. Results The demographic data of the groups were similar. NRS scores in all three groups were significantly lower at 1 and 6 months (p 0.001, p 0.001, p 0.001, respectively). At the first and sixth months, there was no significant difference between the groups in patients who experienced a 50% reduction in pain intensity (p=0.1, p=0.7, respectively). Patients who had back surgery had a significantly lower rate of pain regression (p=0.001). Conclusion In patients with lumbar facet syndrome, RFT application in every 3 degrees and seconds is effective because it generates equal energy, and there was no significant difference in pain relief between the groups.

Introduction The rationale for this case report was to identify the strengths and weaknesses associated with prescribing the Turkish Get-Up as an isometric shoulder and neck exercise. The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. Discussion The Turkish Get-Up was selectively applied as a therapeutic corrective intervention to a patient suffering a mild to moderate cervical, acromio-clavicular and sterno-clavicular joint sprain with associated facet syndrome and muscle spasm. There were concerns that initially gave a guarded prognosis with the realization that further imaging may be warranted after an initial trial. Conclusion The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. This exercise allowed the injured patient to integrate full body movement and conditioning with an emphasis on pain free isometric shoulder and cervical spine contractions to re-establish strength and motor control. The patient now has the ability to add to his training and rehabilitation an exercise that can be endlessly progressed to build continuous strength, endurance and motor control.

Background: Facet syndrome is an articular disorder related to the lumbar facet joints and their innervations, and produces both local and radiating pain. Objective: The purpose of this study was to evaluate the outcome of steroid injection in treatment of facet joint arthropathy. Patient and Methods: This study was held on 23 patients suffered from chronic low back pain due to facet arthropathy at Al-Azhar University and Alharam Specialized Hospitals. There were 11 males and 12 females with mean age 46.27 years (28 to 60 years). History, clinical examination, x-ray, MRIs were done to all patients. Results: Pain was evaluated by VAS. The mean VAS pre injection was 8.1 ± 0.83 ranging from 6:10. Immediately post injection, the mean was decreased to 3.7 ± 0.85 ranging from 2:5. Six weeks after injection the mean was decreased to 3.6 ± 0.98 ranging from 2:5. Twelve weeks after injection the mean was elevated to 5.3 ± 0.91 ranging from 4 to 6. The mean ODI improved from 36.5 ± 6.9 to 21.1 ± 4.2 three months post injection. Conclusion: intra-articular facet joint injection is crucial in the diagnosis and treatment of facet joint syndrome. It is an easy to perform and effective treatment for temporary pain relief. The pain relief is sustained longer in patients with grade G2 and G3 of facet joints

Pain in the lumbar spine is the most common among people of working age. All open surgery, including endoscopic, to eliminate a disc-radicle conflict, associated with a large number of complications. This increasingly encourages doctors to use conservative and minimally invasive techniques. This article presents modern methods of treatment of facet syndrome: chemical denervation, radiofrequency ablation, intraarticular injection of drugs into the cavity in the intervertebral joints. Further research work revealed modern methods of treatment of elimination of a disc-radicle conflict: chemical denervation of the disc, chemonucleolysis, mechanical decompression, intradiscal used electrothermal therapy, laser nucleotomy, hydrodiscectomy, nucleoplasty, laser disc reconstruction. The pathogenetic substantiation of the above methods is considered, the positive and negative sides of each of them are revealed. Presented their own clinical results the Results showed a 70-80% efficiency in the next observation period without serious complications.

BACKGROUND: Facet osteosynthesis can be performed to treat facet syndrome (FS) and reduce spinal instability following laminectomy in patients with lumbar spinal stenosis (LSS). The present study evaluated clinical and radiological outcomes following facet osteosynthesis with the FFX device. METHODS: Patients with FS or LSS were prospectively enrolled in a single-arm, multicenter study. The device was placed at affected levels with or without concomitant posterior lumbar interbody fusion (PLIF) procedures. The visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Computed tomography scans to assess fusion and migration were performed 1 year following surgery. RESULTS: Fifty-three patients (26 men/27 women) with a mean age of 65.0 ± 9.6 years (range: 37–83 years) were enrolled. A total of 205 FFX devices were implanted with 15 patients undergoing concurrent PLIF procedures. There were no intraoperative or postoperative surgical complication reported, and no patient required revision surgery. Mean VAS leg and back pain scores significantly improved from 5.57 to 2.09 (P < .001) and 5.74 to 3.13 (P < .001), respectively, between the preoperative and 1 year follow-up assessments. Mean ODI scores also significantly improved from 44.7% to 24.0% (P < .001) during the same time period. Facet fusion occurred with 86.3% of device placements after 12 months. There was 1 (0.5%) asymptomatic device migration. Eight devices (3.9%) were considered misplaced. CONCLUSIONS: The use of the FFX device is associated with a significant reduction in both pain and disability following surgery with a high facet joint fusion rate. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: This is the first study reporting clinical experience using the FFX device to facilitate facet osteosynthesis. The ability of the device to relieve pain, reduce disability, and enhance lumbar facet fusion with a low rate of device misplacement and migration was demonstrated.

BACKGROUND AND OBJECTIVES: Facet syndrome has increasingly been recognized as one the most common causes of chronic low back pain, despite the significant diagnostic challenges imposed by its protean manifestations. Lumbar zygapophyseal degenerative changes are considered the main etiologic agent in cases of facet-associated lumbar pain, with iatrogenic causes rarely involved, particularly those related to retained foreign bodies following invasive medical or surgical procedures. Only three similar reported cases were found in the literature. CASE REPORT: Female patient, 36 years old, presented significant chronic low back pain due to a Tuohy needle fragment retained in upper part of left L1-L2 facet joint and adjacent tract of the medial branch of the dorsal nerve corresponding to the suprajacent level, following epidural anesthesia performed for elective cesarean section. Failure of conservative treatment and pain intensity led to invasive treatment, with surgical removal of the needle fragment as a stand-alone procedure. Clinical response was favorable, and no additional procedures were necessary thus far. Possible difficulties in diagnosing facet syndrome and the surgical strategy for such an uncommon case are discussed. CONCLUSION: In the case of a rare etiology of low back pain, a particularly accurate clinical and imaging correlation is important to achieve an adequate therapeutic plan. Such plan must encompass an optimal knowledge of spine anatomy and lumbar pain-related mechanisms. Foreign elements that could be responsible for mechanical injury or local inflammatory phenomena contributing to chronic pain should be considered for removal as part of the treatment strategy

Cervical facet disease (aka cervical facet syndrome) is often one of exclusion. This disease implies axial pain from involvement of the posterior spinal column elements. Degenerative changes have been well documented in the literature. The facet joint is a structure which resists compression at higher loads, anterior shear, extension, lateral bending, and torsion (Sial et al., Waldman pain management, 2011). The structure and function of the spine give the trunk of the body stability and mobility, both of which are mediated largely by the zygapophysial joints (facets). The cervical spine is the most mobile of the spinal regions because of its articular shapes and orientations, and laxity of its joint capsules. Active movements of the cervical spine have been measured as up to 70 degrees each of extension and flexion with radiographic study, about 45 degrees of side bending and up to 40 degrees of rotation in either direction (Johnson et al., J Bone Joint Surg Am 59A:332–339, 1977; Alund and Larsson, Spine 15:87–91, 1990). Stability is provided in the cervical spine by the shape of the vertebral processes: the uncinate processes prevent lateral translation and limit side bending; spinous processes limit extension. Further stability is provided by spinal ligaments, the anterior longitudinal ligament, and the posterior longitudinal ligament, ligament flavum, and ligament nuchae (King and Borowczyk, Pain procedures in clinical practice, 2011). Facet joint pain results in referral patterns to the head, shoulders, and upper extremities. Both the synovium and capsule of each facet are richly supplied with nociceptor terminals. Medial branches innervate these facet joints sending afferent pain signals by way of A, D, and C fibers to higher cortical regions.