Lancinating Lumbar Facet Syndrome: a Congenitally Absent Facet Joint

Abstract

Congenitally absent or hypoplastic L5–S1 facet (zygapophyseal) joints are an aberrated rarity, with less than 30 reported cases. This absence of facet joint and contralateral hypertrophic facet provides a continuum of presentations that can complicate low back pain diagnoses and management. A broad differential including lumbar facet syndrome, disc degeneration, spinal stenosis, herniated radiculopathy, spondyloarthropathies and sacroiliac joint pain should be considered initially, with the flexibility for other diagnoses. Understanding the effects of different anatomical, biomechanical and physiological changes on spinal health is essential for patient care. We report a progression of lumbar radiculopathy complicated by the presence of a congenitally absent left L5–S1 facet joint and hypertrophic right L5–S1 facet joint. Furthermore, our discussion concentrates on pathophysiology, differential diagnoses and management of congenitally absent facet joints and the impact they can have on low back pain and spinal health.

Keywords::

• acute pain
• chronic pain
• low-back pain
• pain
• pain assessment
• pain management

Author contributions

PD Vu: this author conducted a literature review, wrote the manuscript and edited it with the assistance of V Bansal, A Malik, A Ryder and JW Chen. This author provided medical care to the patient. V Bansal: this author assisted in the literature review, writing and editing. A Malik: this author assisted in the literature review, writing and editing. A Ryder: this author assisted in the literature review, writing and editing. JW Chen: this author conceived the presented idea, provided discussion and edits for the manuscript, and provided supervision with writing. This author provided medical care to the patient.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient for the inclusion of their medical and treatment history within this case report.