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

Minimally invasive techniques

Other management modalities include facet injections, radiofrequency denervation of the medial branch nerves.


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