Abstract

Introduction: The lumbar facet syndrome is encountered most frequently, it follows that possible ways of its treatment are particularly important. Purpose: Estimation of possibilities of diagnostics and treatment of patients with a lumbar facet syndrome Materials and methods: We used morphological material of 56 facet joints of the lumbar spine taken in the course of the operation of the posterior lumbar interbody fusion on levels L4-5 and L5-S1 for various structural and functional disorders of the lumbar spine; 52 arthrograms of the facet joints. Results of intra-articular blockades (518 patients), data about 428 patients having lumbar facet syndrome which underwent mini-invasive surgical treatment including denervation and percutaneous arthrodesis. 201 patients were treated by way of denervation through electro-coagulation (1-st group) and 211 by way of cryo-destruction (2-nd group). Percutaneous arthrodesis was performed in 16 patients. The results were evaluated by Oswestry scale. Results: Morphological investigation demonstrated the whole range of changes characteristic for the synovial joints. By data of the articular arthrography the picture peculiar to instability, severe arthrosis was determined. In 3 cases diverticuli of the upper turn of the facet joint markedly influencing the formation of clinical symptoms were identified. The results of the intra-articular blockades in the intra-articular group were good - 65%, satisfactory - 33%, unsatisfactory - 2% . In the para-articular group they were good - 58%, satisfactory – 35%, unsatisfactory - 7%. In the course of comparative analysis of the results in first and second group facet denervation we could find significant difference in favor of cryo-destruction. Among the patients with the percutaneous arthrodesis performed 15 patients had good result and in 1 patient the condition was not changed. Conclusion: Variable changes of the facet joints of the lumbar spine play a significant role in the formation of pain syndrome and their diagnostics and treatment demand a special consideration. Application of active tactics in the treatment of the lumbar facet syndrome makes it possible to achieve good results.