Lower back pain is a common disease syndrome that plagues middle-aged and elderly patients. Because of the numerous factors associated with lower back pain, there is often some clinical difficulty in identifying the cause of lower back pain. In recent years, with the development and advancement of medical science, great progress has been made regarding the diagnosis and treatment of lower back pain, which also includes the understanding of intervertebral small joint-derived low back pain.
Anatomy and Etiology
The intervertebral subtalar joints are located posterior to the lumbar spine. The adjacent lumbar vertebrae are connected anteriorly by the lumbar intervertebral discs and posteriorly by the intervertebral subtalar joints on the left and right sides, forming the motor unit of the spine. Similar to other joints in the human body, the intervertebral small joints have articular cartilage on their surfaces, which is relatively smooth and flexible; although the intervertebral small joints are small, they still have enough joint fluid to ensure free movement of the lumbar spine, especially forward flexion and back extension.
Degenerative changes in the spine first appear in the intervertebral discs. With increasing age, the discs become dehydrated and lose height, with subsequent laxity of the small intervertebral joints, increased local stress and cartilage wear. Osteoarthritic changes appear. It is also believed that early injury to the lumbar spine also affects the alignment of the lumbar spine, causing abnormal activity, resulting in cartilage wear and osteoarthritic manifestations that become the cause of subvertebral joint-derived low back pain.
Clinical manifestations
Intervertebral subtalar joint-derived low back pain is usually worse after rest and sleep. Lumbar pain can also be aggravated by lateral flexion or extension of the lumbar spine. Low back pain starts in the middle of the lower lumbar spine and may radiate to the buttocks and sometimes to the back of the thighs. However, it rarely crosses the level of the knee joint. Symptoms of nerve compression such as numbness, weakness and tingling are rarely present. This mechanical pain can be triggered by abnormal activity of the lumbar spine. Osteoarthritic changes in the small intervertebral joints are manifested by bony growths at the edges of the joints. This sometimes causes narrowing of the intervertebral foramina. This may cause compression of adjacent nerve roots, causing neurogenic symptoms.
How is intervertebral small joint low back pain diagnosed?
Your doctor will first need to take a detailed medical history, ask you about the details of your low back pain, and find out how it affects your daily life, such as whether it is accompanied by radiating pain and weakness in the lower extremities, and in what position the lumbar spine is in when your low back pain symptoms are least or most severe.
During the physical examination, the doctor will also find out if your low back activities can trigger your low back pain or other symptoms such as skin sensation, muscle strength and nerve reflexes in the lower extremities.
X-rays
Your doctor can look at the bone changes around the small intervertebral joints on X-rays. There is no narrowing of the intervertebral space and there is no osteophyte growth in the intervertebral joints.
MRI
MRI is unique in its observation of soft tissues. It can clearly reflect the image of the small intervertebral joints and observe whether there is enlargement and swelling. Contrast enhancement and local puncture are generally not required.
CT
Provides the physician with a cross-sectional x-ray image. You can see whether there is erosion of the articular surface of the intervertebral tuberosity and whether there is bone formation.
Injection of the intervertebral subtalar joint
It is both a treatment and a diagnostic test.
Single-photon nuclide bone scan examination
Aids in the diagnosis of intervertebral small joint-derived low back pain. The sensitivity and accuracy are satisfactory.
Treatment of intervertebral small joint-derived low back pain
Non-surgical treatment
Bed rest with a cushion behind the knee while lying on the side or in a flat position can help to relieve the stress on the intervertebral small joints and reduce pain. Non-steroidal anti-inflammatory and analgesic drugs, aspirin, and muscle relaxants can reduce symptoms. Sometimes, oral hormones may also improve symptoms. Physical therapy also has a role in the treatment of intervertebral subtalar joint-derived pain. Traction can reduce the local stress on the intervertebral subtalar joint and reduce symptoms. Strength training can increase the strength of the lumbar and abdominal muscles, and aerobic training can improve heart and lung function.
In addition to the above methods, intervertebral small joint injections are also an important conservative treatment. The injections are usually corticosteroids combined with local anesthetic drugs. For many years, our hospital has used CT-located intervertebral small joint puncture injection, which has a high accuracy rate and reliable short-term efficiency.
Surgical treatment
Mainly related to nerve branch neurectomy and posterior lumbar spine fusion. In recent years, non-fusion technology of the lumbar spine has developed rapidly, and some authors believe that non-fusion technology will play an important role in the treatment of intervertebral subtalar joint-derived low back pain. Selective articular branch neurotomy, a minimally invasive approach, is used to cut small nerve branches and block the transmission of nerve impulses to relieve pain. The principle of fusion surgery in the posterior lumbar spine is to reduce pain symptoms by fusing small intervertebral joints and blocking undesirable stresses. The non-fusion technique, on the other hand, is performed by implanting a specially designed device in the lumbar spine that reduces the stresses acting on the intervertebral subtalar joints.
In conclusion, the intervertebral subtalar joint is one of the major causes of low back pain in addition to the lumbar disc. It has its own special characteristics in terms of diagnosis and treatment. It deserves the attention of the patients and doctors.