Treatment for lumbosacral facet syndrome
Treatment for lumbosacral facet syndrome usually includes a
multidisciplinary approach. If the diagnosis is uncertain, consideration
is given to performing diagnostic medial branch blocks.
Non operative Treatment
Non operative management
includes oral medications such as NSAIDs, acetaminophen, and oral steroids
during acute flares. Additionally, weight loss and physical therapy have
demonstrated successful outcomes.
More invasive non operative
modalities that can be considered include a CT-guided aspiration. The
literature is controversial with respect to the overall effectiveness of
this modality. Patients should also be counseled regarding the risk of
facet cyst recurrence and return of symptoms even after the aspiration is
performed.
Surgical Treatment
Indications for surgical intervention include:- Symptoms refractory to non operative modalities (e.g. 3 to 6 month trial)
- Large associated synovial facet cyst correlating with clinical exam and presentation
- Laminectomy with decompression is the classic first line treatment for symptomatic, intraspinal synovial cysts
- The literature also supports the utilization of facetectomy, decompression, and instrumented fusion (as opposed to a simple "lami decompression")
Minimally invasive techniques
Other management
modalities include facet injections, radiofrequency denervation of the medial branch nerves.
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