Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8545
Peer-review started: May 18, 2021
First decision: June 24, 2021
Revised: June 27, 2021
Accepted: July 26, 2021
Article in press: July 26, 2021
Published online: October 6, 2021
Lumbar facet joint syndrome (LFJS) is a pain condition arising from lumbar facet joint diseases. Treatments of LFJS includes patient education, oral medication, bed rest, physical therapy, and procedural interventions. For some refractory cases that fail conservative therapies, dorsal ramus medial brunch radiofrequency ablation is warranted. However, as nerve fibers can regenerate, their efficacy is impermanent, and the recurrence rate is relatively high. Considering synovial impingement is a paramount pathogenesis of LFJS, in this case, we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope. As the culprit hyperplastic joint capsule was excised, it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.
A 40-year-old female patient was diagnosed with LFJS. She complained of low back pain and right buttock pain for half a year. The patient was placed in the prone position. After disinfection and draping, a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process. Subsequently, a guidewire, dilating tubes, and a working cannula was inserted successively. The spinal endoscope was positioned in the working cannula. Under the endoscope, the microvascular tissue, muscle tissue attached on the L5 inferior articular process and S1 superior articular process, as well as the capsule and minor portion of the inferior articular process were removed. After the joint space was clear and no bleeding points existed, the endoscope and working cannula were shifted, and the incision was sutured. After treatment, the symptoms were completely relieved. The patient was pain-free during the follow-up period of 6 mo.
The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS, especially for cases caused by synovial impingement.
Core Tip: For intractable lumbar facet joint syndrome (LFJS), medial branch radiofrequency ablation is a commonly used therapy. However, the recurrency rate of radiofrequency treatment is relatively high. In this case, we removed the lumbar facet joint capsule and articular process partially through the guidance of endoscope. The patient's symptoms were relieved for the next 6 mo. We assert that this treatment can generate long-lasting efficacy as this innovative treatment directly removes the hyperplastic joint capsule. It is supposed to be an effective treatment for LFJS caused by synovial impingement.