Lumbar Facet Syndrome Research Articles

Specific therapeutic methods in lumbar facet syndrome tratment: prliminary study

Introduction: Specific therapeutic methods (STM) are manual techniques used to treat tissue blockade.Aim of this research is to determine efficacy of STM in treatment of lumbar facet syndrome (LFS).Patients and methods. The study included 60 patients suffering from LFS (65% women) aged ~47. The patients were treated ~24 days with the following 2-8 procedures: osteopathy, “myofascial release”, acupuncture, acupressure, “cupping”, neurodynamic, proprioceptive neuromuscular facilitation, kinesiotherapy, “kinesio-type taping”, homeopathy and electrotherapy. All patients were evaluated at admission and discharge through: a. pain scale with visual analogue scale (VAS) marked with numbers 1 to 10 (1 being state of no pain, 10 being state of maximum pain); b. disability with so-called Oswestry index (ODI) expressed in percentages (0-20% being minimum, 80-100% being complete disability); c. quality of sleep, rated through modified Pittsburgh index of sleep quality (PSQI) expressed between 0 (very poor) and 4 (very good). The assessment of improvement in pain intensity and level of disability was conducted via subtraction of values noted before treatment from values at the end of treatment, while the assessment of sleep quality improvement was conducted via subtraction of values noted at the end of treatment from the values noted before treatment. Non-parametric statistical analyses were used. Results: significantly lower values of VAS (p<0.0001) and ODI (p?0.0001), significant increase in PSQI (p?0.0001) at the end in relation to the beginning of treatment, as well as significant correlation between decrease in pain and disability (r=0.3292, p=0.0105). No significant difference in pain (p=0.9856) and disability (p=0.9171 decrease was noticed between sexes.Conclusion: STM is efficient in the treatment of pain attacks in patients of both sexes suffering from LBS.

Musculoskeletal mimics of lumbosacral radiculopathy.

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

"Percutaneous Ultrasound Treatment of Lumbar Facet Syndrome: A Systematic Review."

Lumbar facet syndrome is a cause of pain. The diagnosis iconfirmation is achieved through a selective block. Although this procedure is standardized under fluoroscopic or computed tomography (CT) guidance, the current use of ultrasound may provide an alternative to its implementation. A systematic literature search was conducted. "ultrasound-guided lumbar" and "lumbar facet joint." Twenty articles were included. Five randomized clinical trials, 4 observational studies, 2 clinical trials, 1 retrospective study, 2 metanalysis and 5 cadaveric studies, and 1 feasibility study. The studies demonstrated a improvement in pain with ultrasound. However, no significant differences in these outcomes were found when comparing ultrasound with fluoroscopy or CT. It was also observed that the procedural time was longer with ultrasound. Finally, success rates in correctly locating the injection site ranged from 88% to 100% when confirmed with fluoroscopy or CT. Although the use of ultrasound for regional anesthesia is on the rise, there are no results that can replace those found with fluoroscopy or CT for performing the dorsal and medial branch block of the spinal root in the treatment of lumbar facet syndrome.

The effect of conventional physiotherapy and median nerve radiofrequency therapy on kinesiophobia in lumbar facet syndrome

Aim: This study was carried out to investigate the effect of conventional physiotherapy (CPT) and median nerve radiofrequency therapy (MNRFT) on kinesiophobia in patients with lumbar facet syndrome (LFS). Methods: The sample of this study consisted of 60 patients over 18 with facet joint pain persisting for at least 3 months and unresponsive to medical treatment were included in the study. The patients were divided into CPT and MNRFT groups of 30 patients each according to the treatment they received. The patients were evaluated for pain severity, kinesiophobia, sleep quality, functional status, and depression both before the treatment and one month after the treatment using the Visual Analogue Scale (VAS), Tampa Scale for Kinesiophobia (TKS), Pittsburgh Sleep Quality Index (PSQI), Oswestry Disability Index (ODI) and Beck’s Depression Inventory (BDI), respectively. Results: There was a significant difference between the pre- and post-treatment VAS, PSQI, ODI, and BDE scores in both the CPT and MNRFT groups. Additionally, there was a significant difference between the pre- and post-treatment TKS scores in the RFT group, but not in the CPT group. There was no significant difference between the groups in any of the pre-treatment scores. There was also no significant difference between the groups in the post-treatment scores, except for the TKS scores. Conclusion: The study findings indicated that MNRFT and median nerve blockade reduced kinesiophobia more than CPT.

Lancinating lumbar facet syndrome: a congenitally absent facet joint.

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 (LBP) 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 LBP and spinal health.

Tension Distension Sign (Acevedo’s Sign) for the Diagnosis of Lumbar Facet Syndrome: Technical Note

The treatment of low back pain has evolved from an understanding of its pathophysiology, biomechanics, and therapy. The events that characterize the degenerative cascade of modifications that produce pain are well described. Facet joints are early affected when there is a loss of intervertebral disc height and may present biomechanical overload that translates into pain. Clinical diagnosis of lumbar facet syndrome is not straightforward because there are no specific features other than pain triggered by hyperextension+forced rotation of the lumbar spine in a standing position to suspect it. This implies that its diagnostic confirmation depends on bone scintigraphy and selective anesthetic blockade of the dorsal and medial branches of the joint. In this technical note, we present a new clinical sign (Tension Distension Signo sign/Acevedo's sign) described since2004.

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Chronic Lower Back Pain in Weight Lifters

» Chronic lower back pain (LBP) is common in both nonathletes and weight lifters, but the diagnosis and treatment should be approached differently in these 2 populations based on the unique movement patterns causing the pain.» Injury rates of weight lifters are far less than those of contact sports, ranging from 1.0 to 4.4 injuries per 1,000 workout hours. However, the lower back was consistently one of the top 2 injury sites for weight lifters, accounting for anywhere from 23% to 59% of all injuries. LBP was most often associated with the squat or deadlift.» Guidelines for evaluating general LBP are applicable to weight lifters, including a thorough history and physical examination. However, the differential diagnosis will change based on the patient's lifting history. Of the many etiologies of back pain, weight lifters are most likely to be diagnosed with muscle strain or ligamentous sprain, degenerative disk disease, disk herniation, spondylolysis, spondylolisthesis, or lumbar facet syndrome.» Traditional recommended therapies include nonsteroidal anti-inflammatory drugs, physical therapy, and activity modification, which are often insufficient to resolve pain and prevent injury recurrence. Because most athletes will want to continue to lift weights, lifting-specific behavior modifications focused on improved technique and correcting mobility and muscular imbalances are important aspects of management in this patient population.

CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY

Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] < 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] < 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] < 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.

Effects of Pulse Radiofrequency Application on Health-Related Quality of Life in Patients with Lumbar Facet Syndrome

Pulse radyofrekans (PRF) tedavisi lomber faset sendromuna (LFS) bağlı ağrı tedavisi için analjezi sağlamada alternatif tedavi olarak önerilmektedir. Bu çalışmada klinik başarının yanında sağlıkla ilgili yaşam kalitesi üzerine etkinliğinin değerlendirilmesi amaçlanmıştır. LFS nedeni ile PRF uygulaması yapılan hastalarda klinik etkinliği değerlendirmek için Vizüel Ağrı Skalası (VAS) ve Oswestry Özürlülük İndeksi (OÖİ) kullanıldı. Sağlıkla ilgili yaşam kalite değerlendirmesi ise Medical Outcome Study Short Form-36 (SF-36) ile yapıldı. Değerlendirme işlem öncesi, işlem sonrası birinci ay ve on ikinci ayda yapıldı. Toplam 12 hastaya PRF uygulaması yapıldı. İşlem öncesi ile işlem sonrası birinci ay ve on ikinci ay VAS ve OÖİ değerlerindeki değişiklikler istatistiksel olarak anlamlıydı (p<0.001). Aynı şekilde SF-36 değerlendirmesindeki değişiklikler de işlem öncesine göre işlem sonrası birinci ay ve on ikinci ayda anlamlıydı (p<0.001). LFS hastalarında PRF uygulaması ağrı üzerinde iyileştirici etkiye sahiptir. Lomber faset sendromuna bağlı oluşan bel ağrılarının hastalarda sağlıkla ilgili yaşam kalitelerini bozduğu tedavi sonrasında ise tatmin edici yaşam kalitesine kavuşmaya yardım ettiği tespit edildi. Bu tarz ağrılarda PRF uygulamasının etkinliği akılda tutulmalıdır.

Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review.

Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

A Pragmatic Randomized Prospective Trial of Cooled Radiofrequency Neurotomy of the Medial Branch Nerves Versus Facet Joint Injection of Corticosteroid for the Treatment of Lumbar Facet Syndrome: 12 Month Results

A Pragmatic Randomized Prospective Trial of Cooled Radiofrequency Neurotomy of the Medial Branch Nerves Versus Facet Joint Injection of Corticosteroid for the Treatment of Lumbar Facet Syndrome: 12 Month Results

First-Time Lumbar Medial Branch Radiofrequency Ablation: Patient-Reported Outcomes Measurement Information System as a Metric of Outcome

ObjectiveTo investigate the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) to capture the therapeutic effect of first-time medial branch radiofrequency ablation (RFA). DesignBefore-after trial. SettingSingle academic spine center. ParticipantsPatients who underwent first-time medial branch RFA for lumbar facet joint pain identified by dual comparative medial branch block with ≥80% pain relief between January 1, 2015 and September 1, 2019 were identified using procedural billing codes. Charts were reviewed manually to confirm accuracy and strict adherence to the 80% pain relief threshold for each medial branch block. Thirty-nine patients met the criteria and were included in this study (N=39). InterventionsMedial branch RFA. Main Outcome MeasuresPROMIS score domains of Depression, Pain Interference, and Physical Function collected pre- and post RFA were compared. Pretreatment scores were within 6 weeks prior to the first medial branch block. Posttreatment scores were between 5 weeks and 6 months after RFA. Paired-sample t test analyses were used to calculate responsiveness to treatment, with significance assigned as P<.05 prior to acquiring data. Effect size was calculated using Cohen's d. ResultsPROMIS domains of Pain Interference and Physical Function demonstrated a statistically significant improvement (P=.004 and P=.017, respectively). The PROMIS domain of Depression did not demonstrate a statistically significant change (P=.12). The effect size was medium (d=−0.43) for Pain Interference, small/medium (d=0.31) for Physical Function, and small (d=-0.12) for Depression. ConclusionsMedial branch RFA as a treatment for lumbar facet syndrome is associated with a statistical improvement in PROMIS domains of Physical Function and Pain Interference.

The effect of consecutive facet medial branch radiofrequency denervation and dorsal root ganglion pulse radiofrequency therapy on lumbar facet joint pain.

The aim of this study was to evaluate the efficacy of consecutive facet medial branch (FMB) radiofrequency denervation (RFD) and dorsal root ganglion pulse radiofrequency (DRG PRF) therapy in patients with chronic lumbar facet joint pain. The study included 27 patients with chronic lumbar pain who had ≥50% pain reduction after FMB block for suspected lumbar facet syndrome and subsequently underwent FMB RFD together with PRF to the adjacent DRG. The patients were retrospectively analyzed in terms of age, gender, pre-procedure symptom duration, history of previous back surgery, FMB RFD and DRG PRF level and side, and numerical rating scale scores immediately before and at 1, 3, and 6 months after the procedure, and subjective pain reduction at 6 months post-treatment. Treatment success was defined as ≥50% subjective pain reduction at 6 months. A total of 19 women and 8 men with a mean age of 57.7±12.4 years were analyzed. Twenty patients (74.1%) had no prior history of low back surgery. The success rate of the procedure in terms of subjective pain reduction at 6 months was 82.5% (n=25). The subjective percentage of pain reduction at post-procedure 6 months was significantly lower in patients with a pre-procedure symptom duration of 12 months or longer compared to those whose pre-procedure symptom duration was <12 months (p=0.04). Our study results show that the analgesic efficiency of DRG PRF added to FMD RFD treatment can be increased in patients with short symptom durations.

Clinical report of lumbar facet syndrome complicated with lower limb symptoms without lumbar spinal canal stenosis

Clinical report of lumbar facet syndrome complicated with lower limb symptoms without lumbar spinal canal stenosis

Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial

ObjectiveThe purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). MethodsThis was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. ResultsThe most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). ConclusionFor the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.

Facet Median Branch Radiofrequency Thermocoagulation Treatment at Different Temperatures and Durations in Patients with Lumbar Facet Syndrome: A Randomized Controlled Double-Blind Study.

To evaluate the effect of various temperatures and durations of radiofrequency thermocoagulation (RFT) for the treatment of low back pain that is caused by facet joints. This is a randomized controlled, double-blind study. Patients diagnosed with facet syndrome were randomly divided into three groups. RFT was applied to the medial branches, which received senses from the facet joint 90°C 50 seconds in 31 patients, 85°C 60 seconds in 32 patients, 70°C 90 seconds in 33 patients at constant current and impedance values. Numeric Rating Scale (NRS) scores before and after the treatment (1 and 6 months), the need for additional analgesics after treatment, and opioid dose changes were recorded. The demographic data of the groups were similar. NRS scores in all three groups were significantly lower at 1 and 6 months (p < 0.001, p < 0.001, p < 0.001, respectively). At the first and sixth months, there was no significant difference between the groups in patients who experienced a 50% reduction in pain intensity (p=0.1, p=0.7, respectively). Patients who had back surgery had a significantly lower rate of pain regression (p=0.001). In patients with lumbar facet syndrome, RFT application in every 3 degrees and seconds is effective because it generates equal energy, and there was no significant difference in pain relief between the groups.

Clinical Diagnosis Scale for Lumbar Pain of Facet Origin

Abstract INTRODUCTION Lumbar pain affects between 60–90% of people. It is a frequent cause of disability in adults. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays pain produced by the facet joint has no clinical diagnosis. METHODS The study was conducted by means of 6 phases as follows, Phase 1, a systematic review of the literature, Phase 2, a list of signs and symptoms, phase 3, submitted to a committee of experts to discriminate the most significant signs and symptoms, Phase 4, recollection of patients and the evaluation questionnaire was applied, phase 5, selective facet block and subsequent postoperative clinical control, phase 6, propose a clinical scale of diagnosis scale RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome that were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60±11.5 years, analogous visual scale of preoperative pain of 8/10, postoperative of 1.7/10, the signs and symptoms most frequently found included in a diagnostic scale were: 3 symptoms and 3 signs. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. 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.

Percutaneous pulsed radiofrequency treatment of dorsal root ganglion for treatment of lumbar facet syndrome

ObjectivesPercutaneous radiofrequency denervation of the medial dorsal branch is often used for treatment of chronic low back pain originating from intervertebral facets, which is sometimes associated with a low success rate and a higher incidence of recurrence of pain. We theorized that implementing pulsed radiofrequency treatment to dorsal root ganglion would increase the probability of successful pain relief. Patients and Methods150 patients diagnosed with CLBP of a confirmed facet origin were included in a prospective randomized controlled trial and were randomly divided into three equal groups, the first was submitted to percutaneous pulsed radiofrequency treatment of the dorsal root ganglia, the second underwent percutaneous radiofrequency denervation of the medial dorsal branch and the third was a control group that did not receive any radiofrequency treatment. Local injection of a mixture of local anesthetic and a steroid was given to the three groups. Cases were followed for a maximum of 3 years. Results98 (65.3 %) patients were females. By 3 months' post procedure, improvement in VAS was significantly better than pretreatment levels in all groups (p= 0.026); the pulsed radiofrequency treatment group, however, had significantly better incidence of improvement when compared to the other two groups (p= 0.014).The control group lost improvement by 1-year follow-up (p=0.63). At 2 years' follow-up, the pulsed radiofrequency treatment of the dorsal root ganglia group maintained significant improvement (p= 0.041) whereas the medial branch denervation group lost its significant effect (p=0.32).By the end of follow-up period, only pulsed radiofrequency treatment of the dorsal root ganglia group kept significant improvement (p=0.044). ConclusionIn CLBP of facet origin, pulsed radiofrequency treatment of the dorsal root ganglia provides both a higher incidence as well as an extended period of pain relief compared to radiofrequency ablation of the medial dorsal branch of the facet joint.

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

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.