What is the role of surgery during the acute phase of lumbosacral facet syndrome treatment?

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Surgical intervention is not the first-line treatment for the management of LBP, including Z-joint–mediated pain, and the vast majority of patients with LBP improve without surgery. Some circumstances, however, dictate that surgical evaluation is indicated. For example, loss of bowel or bladder function or saddle anesthesia (ie, decreased sensation of the perineal region, such as loss of the ability to feel toilet paper touching the skin) are particularly concerning and require emergent surgical evaluation.

Other red flags that may necessitate surgical evaluation include signs and symptoms of malignancy (eg, rapid, unintended weight loss; cancer history; night pain; radiologic findings), unexplained fever, or rapidly progressing neurologic deficits. Importantly, the practitioner must be alert to these ominous signs (red flags) because they can manifest even later in the course of managing a patient’s LBP.

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