How is lower back pain (LBP) characterized in lumbosacral facet syndrome?

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Z-joint pathology should be considered if the patient describes nonspecific LBP with a deep and achy quality that is usually localized to a unilateral or bilateral paravertebral area.

Provocative injections of the Z-joints have been used to create a sclerotomal map of the Z-joint’s pain referral pattern. Based on these studies, the common referral areas for Z-joint–mediated pain are flank pain, buttock pain (often extending into the posterior thigh, but rarely below the knee), pain overlying the iliac crests, and pain radiating into the groin. However, this pain pattern is not consistently reported in patients with Z-joint pain as confirmed by diagnostic intra-articular Z-joint injections. Therefore, this sclerotomal representation of the Z-joint is only suggestive, not diagnostic.

The pain is often exacerbated by twisting the back, by stretching, by lateral bending, and in the presence of a torsional load. Some patients describe their pain as worse in the morning, aggravated by rest and hyperextension, and relieved by repeated motion. Often, this lumbosacral facet syndrome may occur after an acute injury (eg, extension and rotation of the spine), or it may be chronic in nature.

Unlike other lumbar spine pathologies such as disc herniation, Z-joint–mediated pain likely will not worsen with an increase in intra-abdominal and thoracic pressure. Therefore, worsening of pain with coughing, laughing, or a Valsalva maneuver is suggestive that the Z-joint is not the primary pain generator.

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