Facet syndrome. Minimally invasive surgical treatment. Clinical case with a literature review

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Abstract

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 LII–LIII, LIII–LIV, LIV–LV 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.

About the authors

Vitaliy E. Potapov

Irkutsk Scientific Centre of Surgery and Traumatology

Author for correspondence.
Email: pva454@yandex.ru
ORCID iD: 0000-0001-9167-637X
SPIN-code: 5349-8690

M.D., Ph.D., Senior Research Associate

Russian Federation, 1, Bortsov Revolitsii street, Irkutsk, 664003

Vladimir A. Sorokovikov

Irkutsk Scientific Centre of Surgery and Traumatology; Irkutsk State Medical Academy of Postgraduate Education — Branch Campus of the Russian Medical Academy of Continuing Professional Education

Email: vasorokovikov@mail.ru
ORCID iD: 0000-0002-9008-6383
SPIN-code: 8379-4458

M.D., Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, 1, Bortsov Revolitsii street, Irkutsk, 664003; Irkutsk

Sergey N. Larionov

Irkutsk Scientific Centre of Surgery and Traumatology

Email: snlar@mail.ru
ORCID iD: 0000-0001-9189-3323
SPIN-code: 6720-4117

M.D., Ph.D., Dr. Sci. (Med.), Senior Research Associate

Russian Federation, 1, Bortsov Revolitsii street, Irkutsk, 664003

Alexandr P. Zhivotenko

Irkutsk Scientific Centre of Surgery and Traumatology

Email: sivotenko1976@mail.ru
ORCID iD: 0000-0002-4032-8575
SPIN-code: 8016-5626

Junior Research Associate

Russian Federation, 1, Bortsov Revolitsii street, Irkutsk, 664003

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2. Fig. 1. Magnetic resonance imaging of the lumbar spine: а — a T1-weighted image in the sagittal projection (a hypointensive signal of the articular gap of hypertrophied LIII–LIV arch-process joints, arrow); б — a T2-weighted image in the frontal projection (a hypointensive signal of the articular gap of the hypertrophied LIII–LIV arch–process joints, arrow); в — a T1-weighted image in the axial projection (hypointensive signal of the articular gap of the hypertrophied LIII–LIV arch-process joints, arrow). The severity of degenerative changes in the zygapophyseal LIII–LIV joint on the right corresponds to the IV degree according to A. Fujiwara’s classification.

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3. Fig. 2. Multispiral computed tomography of the lumbar spine: а — axial projection; б — frontal projection; в — sagittal projection. The arrows indicate the hypertrophied zygapophyseal LIII–LIV joint on the right with the phenomenon of the “vacuum effect”.

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Copyright (c) 2021 Potapov V.E., Sorokovikov V.A., Larionov S.N., Zhivotenko A.P.

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