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Lower Back Pain

Anatomy of the Lower Lumbar Spine

The spine in the lower back (lumbar spine) consists of bones (vertebral bodies) separated by cartilage discs (intervertebral discs).  There are joints between the vertebral bones that are similar in structure and size to the joints of the fingers.  These are called facet joints and they allow the spine to twist and bend.  In the lower spine, they are called the lumbar facet joints.  

There are nerves that supply sensation to the facet joints called the medial branch nerves.  It is these nerves that carry the pain messages to the spinal cord and brain when the joints become painful.

Conditions

Causes of Facet Joint Pain in the Lower Back

The bones and discs of the spine will develop 'wear and tear’ changes as a person gets older (osteoarthritis).  The discs become flattened out and the facet joints become worn and less mobile (facet joint arthropathy).  

 

These changes can cause the pain in the lower back. Facet joint pain is typically made worse when these joints are moved.  The supporting muscles next to the joints become stiff and often ‘seize up’ after a period of inactivity, such as sitting or sleeping.  This causes pain and stiffness when the joints are moved again. 

 

Symptons of Lumbar Facet Joint Pain

  • A constant pain:  A dull background ache in the lower back (lumbar region).

  • Intermittent severe episodes of pain:  These can be unpredictable, and occur a few times per month or per year.

  • Pain radiating into the buttocks and thigh:  (It rarely radiates below the knee or into the foot.)

  • Pain that goes around into the groin.

  • Pain that is increased with movement:  The pain is made worse by twisting around or bending backwards.  It is often worse after sitting or standing for long periods.

  • Muscle stiffness and low back pain on waking.

  • Pain that is reduced in certain positions:  Leaning forwards and lying down often reduces the pain.

  • Tenderness to pressure over the lower back.

Lower Back Pain Diagnosis

 

 

It’s like the nerve blocks that are carried out by a dentist.  The nerve is blocked with a freezing solution (local anaesthetic), and if the toothache goes, then it identifies that nerve and tooth as the source of the problem.

History:  

The diagnosis is made from the patient’s description of their symptoms.  

 

Physical examination:  

There are no specific clinical examination tests that will confirm lumbar facet joint pain.  Leaning backwards, and getting the patient to twist the back often replicates the pain. Pressing on the muscles of the lower back often causes discomfort.  

 

Magnetic resonance imaging (MRI) scan of the lumbar spine: 

 This uses radio waves and a strong magnetic field to create images of the body's structures. This investigation is commonly carried out for patients with back pain. It will show the ‘wear and tear’ changes (osteoarthritis) that develop with the ageing process (lumbar spondylosis). 

 

X-ray images: 

 An X-ray picture of the spine will also show these wear and tear changes.  There is a poor correlation between the images shown on the MRI scan and X-rays and the symptoms that a patient might describe.  

 

Diagnostic medial branch nerve blocks: 

 This is the only way of making the diagnosis that the lumbar facet joints are the main source of the low back pain. 

 

 

 

 

 

 

 

 

 

 

The injections are carried out using X-rays to show up the joints of the spine.  A fine needle is then directed down next to the medial branch nerve and a small amount of local anaesthetic is injected.  The patient is asked to keep a record of their symptoms (Pain Diary) after the procedure.  

 

 

If these injections substantially relieve the pain afterwards, then this identifies the facet joints as the principal source of their symptoms.  This is why it’s called a diagnostic nerve block.  The local anaesthetic wears off after several hours, so the pain relief may be short-lived.  It is usual practice to carry out two diagnostic nerve block procedures to confirm the diagnosis.

 

If these injections substantially relieve their pain in the short term afterwards, then this identifies the facet joints as the principal source of their symptoms.  It is usual practice to carry out two diagnostic nerve block procedures to confirm the diagnosis.

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Patient Information (PDFs)

Lower Back Pain Treatment