Facet syndrome: causes, clinical features, diagnosis and treatment

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Abstract

Currently accepted biopsychosocial model of pain in the back, in which the isolated biological component with the identification of anatomic source of pain as well as psychological and social components that contribute to the emergence and maintenance of back pain. The group of patients with non-specific low back pain is not uniform, which requires a differentiated approach to the treatment. The most common sources of back pain are diseased discs, facet joints, sacroiliac joint, muscle spasm, but the definition of the main source of pain is difficult due to the lack of validity of the test used. Facet (facet joints) are the only typical synovial joints of the spine. In the development of the pathology attaches importance to several factors: micro and makrotravmatizatsii, enhancing the load on the joints when disc degeneration, inflammatory lesions in the form of arthritis, similar to other peripheral lesions of synovial joints. Possible mechanisms of pain include stretching of the joint capsule, synovial folds infringement (meniscoids) between the joint surfaces, and compression of the spine osteophytes and joint inflammation in the development of secondary muscle spasm. Facetogenic pain is prevalent in older age groups, more often in women with a higher body mass index. There is no correlation between morphological changes in the facet joints and back pain. The combination of positive and negative test, taking intoaccount the patient's clinical symptoms and complaints can help to identify the main source of pain. "The gold standard" diagnosis is to conduct diagnostic blockade with local anesthetics, performed under the supervision of the neuroimaging with a reduction in pain for at least 70-80%. Treatment of the facet syndrome is carried out according to the general principles of treatment of non-specific back pain using medical methods and non-pharmacological treatment. Drug treatment in the early stages includes a choice of preparations purpose of nonsteroidal antiinflammatory drugs and muscle relaxants.Several studies have shown the effectiveness and safety of baclofen in the treatment of acute and chronic back pain. With the ineffectiveness of 3 months it is recommended to use different versions of blockades and radiofrequencies of facet denervation.

About the authors

A. I Isaykin

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

Email: alexisa68@mail.ru
доц. каф. нервных болезней и нейрохирургии ГБОУ ВПО Первый МГМУ им. И.М.Сеченова, куратор отд-ния боли и заболеваний периферической нервной системы, зам. дир. НОЦ Неврология по лечебной работе 19991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2

I. V Kuznetsov

A.Ya.Kozhevnikov Clinic for Nervous Diseases

зам. гл. врача по мед. части Университетской клинической больницы №3 КНБ им. А.Я.Кожевникова 119435, Russian Federation, Moscow, ul. Rossolimo, d. 11, str. 1

A. V Kavelina

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

аспирант каф. нервных болезней и нейрохирургии ГБОУ ВПО Первый МГМУ им. И.М.Сеченова 19991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2

M. A Ivanova

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

клин. ординатор каф. нервных болезней и нейрохирургии ГБОУ ВПО Первый МГМУ им. И.М.Сеченова 19991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2

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