Clinical Diagnosis Scale for Pain Lumbar of Facet Origin: Systematic Review of Literature and Pilot Study

Abstract

Abstract INTRODUCTION Lumbar pain affects between 60% and 90% of people. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays, the pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this study is to propose a clinical diagnostic scale for lumbar facet syndrome. METHODS A systematic review was made on signs and symptoms of lumbar facet pain, these were then submitted to the consideration of a group of experts and the most important ones were extracted, a questionnaire was later made with the most important signs and symptoms, which were applied to a group of patients subjected to percutaneous blockade for facet pain, and, finally, the pre- and postsurgical results were related to the positive signs, proposing a clinical scale of diagnostic evaluation. RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome, which were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. A total of 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60 ± 11.5 yr, analogous visual scale of preoperative pain of 8/10, and postoperative of 1.7/10. The 3 signs and 3 symptoms most frequently found included in a diagnostic scale were as follows: (symptoms) (1) axial or bilateral axial lumbar pain, (2) improvement with rest, and (3) absence of root pattern, which may have a pseudoradicular pattern; however, the pain is more lumbar than pain in the leg; and (signs) (1) Kemp sign, (2) pain induced in the joint or transverse process, and (3) facet stress sign or Acevedo sign. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. A few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.