Definition of lumbar small joint disorder syndrome: The small joints of the lumbar spine are synovial joints with rich nerve endings in the joint capsule and rich myelinated nerve fibers and capillaries in the synovial membrane of the joint capsule. The small joints of the lumbar spine are close to the sagittal position, which is conducive to the forward flexion and extension of the lumbar spine. When the range of motion is exceeded and cannot be reset, it will embed the synovial membrane and joint capsule, causing a series of clinical symptoms such as lumbar pain and limitation of lumbar spine activities, which is called lumbar small joint disorder syndrome.
I. Etiology
1, small joint dislocation: with age, the lumbar spine small joints and disc degeneration gradually occur, the synovial joint stability is affected, shear stress can be generated, causing small joint dislocation, and even subluxation. It is common that the intervertebral disc degeneration, the narrowing of the vertebral space, the upper and lower synapses can not be properly aligned. Joint capsule, ligamentous laxity resulting in small joint gap during normal activities.
2, small joint synovial embedment: lumbar rotational movement or sudden turning or extension upright when the joint gap side widens, generating negative pressure, synovial membrane is sucked into the joint, when the lumbar extension is straight synovial membrane is caught between the joint surface. The synovial membrane of the joint has the distribution of the medial branch of the posterior branch of the nerve, so it can cause severe pain, and the lumbar spine activity is obviously restricted.
3, small joint osteoarthritis: small joint degenerative arthritis long-term extension and flexion and lateral movement of the intervertebral loosening, increased load per unit joint area, increased stress on articular cartilage and subchondral bone, but also due to damage to the surrounding joint capsule to produce bone superfluous small joint disorders occur.
Second, the clinical manifestations of all ages can develop, and there is no significant difference in the incidence ratio of men and women. Patients are mostly ambulatory workers, usually less active, lack of physical exercise, often have a history of chronic low back pain, most patients have no obvious history of trauma, most sudden onset. Most of the patients have no obvious history of trauma, and most of them have sudden onset when they cough, bend over to pick up things, lift heavy objects or get up from standing for a long time. The pain in the lower back is severe when moving. Patients tend to lie on their sides with flexion and muscle tension and are afraid to move for fear of being touched or moved. Any movement of the spine, coughing, or vibration will make the pain worse. Due to the pain, the lumbar muscles are in protective muscle spasm, the lumbar vertebrae become flat or slightly posteriorly convex or slightly laterally convex, the site of pain is not clear, the lumbar activities are obviously restricted, and it is difficult to turn over and get up. The disease is mainly characterized by lumbar pain, and there is basically no radiating pain in the legs. Examination: sacrospinous muscle spasm, deep pressure pain at the small joints of the lumbar spine, no neural localization signs in the lower limbs, straight leg raising test (-), but when the straight leg is raised and then lowered down, pain in the lumbar region will appear.
III. Auxiliary examination
1.X-ray: most patients have no change in X-ray film, some patients can see small joint asymmetry, joint gap front wide and back narrow, overlap, degenerative hyperplasia, etc. A few patients can have secondary changes such as scoliosis and loss of lumbar physiological anterior convexity.
2.CT: It can be seen that the joint protrusion, joint gap widening, poor alignment, joint degeneration, subchondral sclerosis, intra-articular bone fragmentation, fluid accumulation, gas accumulation and other changes.
If the diagnosis is unclear, CT or MRI examination should be performed, and the diagnosis should be differentiated from the following diseases.
1, discogenic pain: disc degeneration can also cause small joint disorders, so it is more difficult to differentiate from discogenic pain. The pain disappears quickly and is not easy to recur after simple small joint disorders are reset. Discogenic pain is more persistent and difficult to be completely relieved.
2.Lumbar muscle strain: chronic low back pain, no history of acute trauma. Soreness, swelling and pain, relieved after rest, recurrent. More fixed pressure points near the muscle starting and ending points.
3.Supraspinous interspinous ligamentitis: chronic low back pain, confined to the posterior mid lumbar region. The pressure pain point is located in the spinous process and interspinous process and does not radiate.
4. 3rd lumbar transverse process syndrome: spasm of sacrospinous muscle and pressure pain at the tip of the third lumbar transverse process. Local sealing is effective.
5.Acute lumbar sprain: clear history of trauma, obvious pressure pain at muscle attachment points, and pain disappears after local sealing.
V. Treatment principles
1. Oblique wrenching manipulation reset: a safe, fast and effective method to relieve severe lumbar pain and muscle spasm. No anesthesia is needed, and the embedded synovial membrane is released from compression by relaxing the lumbar back muscles and quickly rotating the reset. Personally, I think this treatment method can be the first choice and necessary treatment method for lumbar small joint disorder syndrome. However, the operator is required to be experienced and in place, otherwise it is easy to fail to achieve the effect, or aggravate the symptoms.
2, acupuncture, massage, physical therapy: promote blood circulation, reduce pain, but can not be used as the main treatment method, can be used as an auxiliary treatment method after the manual reset.
3.Local closure: good effect of pain relief in the short term, but cannot solve the problem at root, if you cannot find a doctor who knows how to manipulate, it can be used as a secondary treatment.
4.Lumbar back muscle functional exercise: enhance the stability of lumbar spine and prevent recurrence.
5.Bed rest, oral analgesics and antispasmodics, and various ointments can be applied externally to play a supplementary therapeutic role.
6.Surgical treatment: After the above treatment, 99% of the patients can achieve the effect of cure. If conservative treatment is ineffective and seriously affects life and workers, surgery can be considered. At present, the main surgical methods are lumbar small joint block, ablation, or joint capsule and synovectomy, and very few doctors perform lumbar fusion (I do not agree with this treatment).