Casual observations on the facet joint syndrome

Recent IBM conference for SPSS users, it was suggested that this was the era of machine learning in which mass data screening could define models for examination and predictive analysis could further define such concepts. Our own team were able to start such studies nearly a third of a century ago with the help of the few existing mainframe computers in the world that could cope with the fledgling programs performing these tasks. We were able to examine the complexity of common forms of low back pain, often referred to as non-specific back pain, which in turn implied that the clinical picture was ‘indivisible.’ Within this spread of morbidity, we thought that we could identify half a dozen or so distinct pictures, one of which was subsequently considered to be the manifestation of the elusive facet (zygapophysial) joint syndrome. It would take up far too much room here to review all the work in this field that has been accumulating since the syndrome was originally posited a century ago. But whilst out for my walk earlier this morning, I noticed that my right-sided low back pain was worse. I have all along believed that this trouble has been due to a predominantly unilateral right-sided facet joint syndrome, particularly as the diagnostic system developed from our above-mentioned research had scored me for this explanation. As you do when out walking, I decided to check what was happening. Our existing main criterion for the diagnosis was the paradoxical demonstration of the right-sided low back pain being exacerbated by bending sideways or twisting in the opposite direction, i.e. moves towards the left side. The other syndromes do not do this. Any syndrome can hurt if you bend or twist to the side of the pain, but the ‘contralateral’ phenomenon is seemingly restricted to facet joint involvement. Up until now, I had thought that pain exacerbation on lateral flection, as opposed to rotational movement, might distinguish between involvement of the lowest lumbosacral facet joints and that twisting implicated the joints above at L4/5. On testing, this morning I seemed to get different answers on repeating the tests. I then realized that lateral flexion would induce the contralateral pain only if I was standing whilst doing the test when my posture was slightly bent forwards (flexed). In contrast, lateral rotation induced the contralateral pain if my posture standing was slightly bent backwards (extension). For me, this was an ‘Oh wow!’ moment. I thought I should share these ideas just in case any readers were deciding to set up a study to help differentiate the various forms of back pain presentation. Of the vast number of tests that have been proposed, it is difficult to select a shortlist for inclusion at the outset of such clinical research. A recent editorial criticized a lot of cluster analysis studies for involving an insufficient number of cases and carrying out inadequately sophisticated analytic work. But, whilst this morning’s observations were made on only one case (n= 1) and there were no studies of repeatability, reliability, or validity, I do hope that these suggestions are worth considering, and if not, perhaps further discussion or criticism might be thought worthwhile. One can of course now develop and run such a program on the ubiquitous portable lap top computer. Why, I also ask, is it that I seem to have such trouble in the first place? If osteoarthritis (OA) is the likely mechanism for facet joint involvement, then my problems may have been predestined. My mother had some rheumatics and Heberden’s nodes, and seemingly I may have early such changes. OA is very common and I only have one ‘T’ reducing my risk, according to a genetic profile performed on a spit sample recently. Our industrial studies seemed to suggest that back rotation can in varying degrees induce such problems. Therewas a spread, fromwork being associatedwith frequent twisting, and at the other extreme one or a few such injuries, the latter presumably more forceful on the facet joints. In my teens I may have provoked the latter mechanism with some back strains due to awkward waterentries from high board diving as well as a particular rugby injury. Age is also catching up with me.