Lumbar facet joint instability

Brief introduction of lumbar facet joint instability Lumbar facet joints (facetjointoflumbar) instability refers to lumbar facet joint instability (also known as facet joint subluxation or facet joint dislocation) due to trauma, degenerative changes and congenital development, and causes low back pain, limited mobility and other A series of symptoms; at this time, most of the combined synovial incarceration, bed rest can improve symptoms, generally more curable. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: kidney deficiency and low back pain

Causes of lumbar facet joint instability

Lumbar spine receives external force (85%):

The lumbar facet joint consists of the inferior articular process of the superior vertebral body and the superior articular process of the lower vertebral body. The articular surface is covered by hyaline cartilage and has a small joint cavity surrounded by a joint capsule. The joint capsule is loose and thin. The layer is a synovial membrane that secretes synovial fluid to facilitate joint activity.

When the lumbar vertebrae are subjected to excessive vertical load stress or excessive shearing of the lumbar vertebrae, the small joints are prone to damaging synovitis, resulting in malnutrition of the articular surface cartilage, thinning of the cartilage surface, cracking, and uneven joint surface. Degeneration of the subchondral bone can also occur, the bone becomes hard, the joint capsule can be torn after being subjected to overload stress or severe rotational stress, and the fiber scar is formed. When the intervertebral disc is degenerated and the intervertebral space is narrowed , can cause the small joint capsule to relax, directly causing subluxation of the facet joint.

Pathogenesis

The joint capsule of the lumbar facet joint consists of two layers: fibrous structure and synovial membrane. The synovial membrane is rich in blood vessels and nerves. The nerves distributed in the facet joints are the posterior branch of the spinal nerve. The posterior branch is divided into the inner and outer branches. There are small branches, forming a very rich neural structure, that is, small joint receptors. When the synovial membrane is mechanically or chemically stimulated, it produces obvious pain. The joint surface of the lumbar segment is approximately sagittal, front The ligamentum flavum is strengthened, and some interspinous ligaments are strengthened at the rear. The rotation of the lumbar spine is restricted by the small facet joints. When the lumbar facet joints are subjected to rotational violence, the injury is easy to occur. When the spine is flexed by 50° to 60°, the injury is caused. Mainly occurs in the lumbar region, when the lumbar flexion occurs, the small joints are separated, the small joints converge when the waist is stretched, and the vertebral bodies are twisted when the vertebral body is twisted. The other side of the facet joint is closed, and the other side is opened. When the adult reaches adulthood, the intervertebral disc and ligament Different organizations have different degrees of degenerative changes. If they are not fully prepared, sudden spine rotation activities such as waist twisting, bending and taking objects, sweeping the ground, etc. will result from vertebral body and intervertebral tissue. In the unstable state, it is subjected to a large force, and the small joint is malocclusion or misplacement. The range of motion of the waist 5 is large, and the small joint is prone to open. When it is opened, the negative pressure in the small joint cavity is increased, and the joint capsule is slippery. The membrane is inhaled and clamped to form a small joint synovial incarceration.

Recently, some people have studied the anatomical and histological study of the "meniscus-like structure" in the posterior lumbar spine. It is believed that this structure may be the structural basis of the lumbar facet joint synovial incarceration and facet joint syndrome. The nerve endings of this structure may be one. Nociceptive receptors cause pain when the meniscus-like structure itself is stimulated by compression.

Lumbar facet joint instability prevention

Moderate sports are appropriate:

Lumbar spondylosis prevention sports may cause impact on the spine, squeezing force, extreme rotation, flexion and other sports will cause damage to the lumbar spine, causing early degeneration or aggravation. Understand these mechanisms and help people choose and regulate sports.

Waist health care exercise: adhere to the waist health care exercise, often carry out activities in all directions of the lumbar vertebrae, so that the lumbar vertebrae always maintain physiological stress state, strengthen the lumbar muscles and abdominal muscles exercise, which is also one of the prevention methods of lumbar spondylosis. The strength of the psoas and abdominal muscles can increase the stability of the lumbar spine, strengthen the protection of the waist, and prevent degenerative changes in the lumbar spine.

Correct use of the waist: lumbar spondylosis prevention should be squat first when lifting heavy objects, waist position should be changed when the waist is too long, and waist activity should be done to prevent gradual strain, and the waist is excessive or has been produced due to the nature of work. In the case of mild strain, the strain should be further aggravated and eventually cause degeneration of the lumbar spine.

Lumbar facet joint instability complications Complications, kidney deficiency, low back pain

Can be complicated by small joint synovial incarceration and facet joint subluxation.

Lumbar facet joint instability symptoms Common symptoms Lower back pain lumbosacral pain Compulsive orthostatic nerve root stimulation

1. Low back pain: Most of the patients are young and middle-aged. In the acute attack, most of the patients immediately have unilateral or bilateral lower back pain during the process of twisting or bending and bending into the waist. The pain in the active waist is intensified, even to the buttocks and thighs. And the tail and tail radiation, generally do not involve the calf, the patient is often in a position of force, fear of being touched or moved by others.

2. Symptoms of nerve root irritation: There may be symptoms of nerve root irritation in the early stage, and lower extremity pain may occur. Generally, the range involved is slightly smaller, and it does not spread according to the distribution of nerve roots. When the nerve root is involved, the Achilles tendon reflex may be weakened or disappeared. .

3. Signs: In the acute attack, the physiological curvature of the waist disappears, the spinous processes are irregularly arranged, and the small joints of the lesions have obvious slap pain and tenderness. The prosthetic joints with procaine or lidocaine can be partially closed. Reduce pain, lower limb muscle strength, and feel no abnormalities.

Examination of lumbar facet joint instability

X-ray examination showed that the physiological curvature of the lumbar spine changed. It is generally difficult to find the displacement of the small joint, but the dynamic lateral radiograph can show the loose sign, and the bilateral articular processes can be found to be asymmetrical, and the left and right oblique positions can sometimes be seen. Embedded in the isthmus, CT and MRI images can show the profile of the affected vertebrae and surrounding soft tissue.

Diagnosis and diagnosis of lumbar facet joint instability

diagnosis

1. Clinical symptoms and signs are seen in young adults, mostly in the process of sudden twisting or bending from waist to waist. It is characterized by severe pain, limited waist activity, obvious tension of the sacral spine, stiffness of the waist, lumbosacral There are tenderness and sneezing pain in the department.

2. Closed therapy: 5 to 10 ml of 1% procaine is injected into the small joint of the lesion, and the symptoms are relieved or disappeared after a few minutes, which is helpful for the diagnosis of the disease.

3. Imaging findings: X-ray examination shows that the physiological curvature of the lumbar spine changes, generally it is not easy to find small joint displacement, but the dynamic lateral radiograph can show loose sign, and the bilateral articular processes can be found to be asymmetric, left The right oblique position is sometimes seen in the isthmus, and CT and MRI images can show the profile of the affected vertebrae and surrounding soft tissue.

Differential diagnosis

Differentiation from lumbar disc herniation.

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