LUMBOSACRAL FACET SYNDROME: FUNCTIONAL AND ORGANIC DISORDERS OF LUMBOSACRAL FACET JOINTS
Autori:
Vjekoslav Grgić
Sažetak
Poremećaji lumbosakralnih (LS) fasetnih zglobova manifestiraju se križoboljom s prenesene boli u nozi ili bez nje i smanjenom pokretljivošću LS kralježnice (LS fasetni sindrom). Najčešći uzroci LS fasetnog sindroma jesu funkcijski poremećaji (funkcijska blokada ili disfunkcija fasetnog zgloba = reverzibilno ograničenje pokreta fasetnog zgloba uzrokovano uklještenjem meniskoida) i degenerativne promjene fasetnih zglobova, dok su drugi poremećaji rjeđi (spondiloartropatije, infekcija, tuberkuloza, sinovijalna cista, ozljeda). Iako je dokazano da su fasetni zglobovi jedno od najčešćih izvorišta kronične boli u križima (15–45%), činjenica je da se fasetni sindrom često previdi u bolesnika s kroničnom križoboljom. Glavni razlozi kojima se može objasniti zašto se fasetni sindrom previdi u bolesnika s kroničnom križoboljom jesu ovi: 1. poremećaji fasetnih zglobova manifestiraju se nespecifičnom kliničkom slikom, 2. dijagnoza fasetnog sindroma ne može se postaviti uobičajenim kliničkim pregledom, a ni radiološkim pretragama, 3. malen broj liječnika prakticira manualni funkcijski pregled kojim se može postaviti dijagnoza disfunkcije fasetnog zgloba i 4. dijagnostička anestetička blokada kojom se može potvrditi dijagnoza fasetnog sindroma nije široko dostupna metoda. Nedostaju istraživanja o učestalosti fasetnog sindroma u bolesnika s akutnom križoboljom. Kronična mehanička bol u križima uzrokovana disfunkcijom više strukturno nepromijenjenih fasetnih zglobova može imati ista obilježja kao upalna bol, što može rezultirati pogrešnom dijagnozom spondiloartropatije. Akutni LS fasetni sindrom uzrokovan disfunkcijom fasetnih zglobova vrlo dobro reagira na manualnu terapiju. Najvažnije terapijske opcije u bolesnika s kroničnim LS fasetnim sindromom uzrokovanim degenerativnim promjenama i/ili disfunkcijom fasetnih zglobova jesu: manualna terapija, kineziterapija (fleksijske vježbe), terapijske blokade i radiofrekventna denervacija. U članku su opisane etiopatogeneza, kliničke manifestacije, dijagnoza, diferencijalna dijagnoza i terapija LS fasetnog sindroma s naglaskom na funkcijske poremećaje fasetnih zglobova koji mogu zadavati osobite dijagnostičke i terapijske teškoće.
Summary
Disorders of lumbosacral (LS) facet joints are manifested by low back pain with or without referred leg pain and decreased mobility of the LS spine (LS facet syndrome). The most frequent causes of LS facet syndrome are functional disorders (functional blockade or dysfunction of facet joint=reversible restriction of facet joint movements caused by meniscoid entrapment) and degenerative changes of facet joints while the others are less frequent (spondyloarthropathies, infection, tuberculosis, synovial cyst, injury). Although it has been proven that the facet joints are one of the most frequent sources of chronic low back pain (15–45%), the fact is that the facet syndrome has been frequently overlooked in patients with chronic low back pain. Following are the main reasons for explaining why the facet syndrome has been overlooked in patients with chronic low back pain: 1. Facet joints disorders are manifested by non-specific clinical picture, 2.Diagnosis of facet syndrome cannot be established by either the conventional clinical examination or radiological examinations, 3. A very small number of doctors are practicing manual functional examination which can establish the diagnosis of facet joint dysfunction and 4. Diagnostic anesthetic block which can confirm the facet syndrome diagnosis is not a widely accessible method. There is a lack of research in frequency of facet syndrome in patients with acute low back pain. Chronic mechanical low back pain caused by dysfunction of several structurally unchanged facet joints can have the same features as the inflammatory pain which can result in misdiagnosis of spondyloarthropathy. Acute LS facet syndrome caused by dysfunction of facet joints responds very well to manual therapy. The most important therapeutic options in patients with chronic LS facet syndrome caused by degenerative changes and/or dysfunction of facet joints are manual therapy, kinesiotherapy (flexion exercises), therapeutic blocks and radiofrequency denervation. The article describes etiopathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy of LS facet syndrome with emphasis on functional disorders of facet joints that can cause particular diagnostic and therapeutic problems.
