Classification of the Congenital Defect of the Lumbar Facet Joint: Case Report and Literature Review

Abstract

Background: Congenital lumbar facet joint defect is a rare congenital developmental disorder with only a few reported cases in the literature, primarily affecting the L5-S1 segments. This study reports the first case of a defect in the left L3 inferior articular process; and presents a review of the existing literature on the subject, proposes a classification system, and validates the inter-observer and intra-observer reliability of this classification system.

Case Presentation: A 14-year-old boy presented to our orthopedic clinic with persistent lower back pain for 1 month. Imaging analysis, including CT scans, 3D reconstruction, and MRI, revealed a congenital lumbar facet joint defect at the L3 level, which has not been reported. Conservative treatment resulted in a significant improvement in his symptoms, and he is currently under follow-up care.

Conclusion: Congenital defect of the lumbar facet joint is a rare spinal condition. This article reports the first patient with a defect in the left L3 inferior articular process and conducts a comprehensive literature review, proposing a classification of articular process defects into five types. The two most common types are Types B and C. We have demonstrated that this system is reliable and reproducible and have described the treatment of each type.

Keywords

Classification system / Congenital defect / L3 articular process / Low back pain / Lumber facet joint

References

[1] Rowe GG. Anomalous vertebrae from the lumbosacral column of man. Anat Rec. 1950; 107(2): 171–179.

[2] Inoue N, Orías A, Segami K. Biomechanics of the lumbar facet joint. Spine Surg Relat Res. 2020; 4(1): 1–7.

[3] Keim HA, Keagy RD. Congenital absence of lumbar articular facets. A report of three cases. J Bone Joint Surg Am. 1967; 49(3): 523–526.

[4] Klinghoffer L, Murdock MG, Hermel MB. Congenital absence of lumbar articular facets. Report of two cases. Clin Orthop Relat Res. 1975; 106: 151–154.

[5] Arcomano JP, Karas S. Congenital absence of the lumbosacral articular processes. Skeletal Radiol. 1982; 8: 133–134.

[6] Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am. 1982; 64(5): 721–729.

[7] Pellegrini VD Jr, Hardy JH. The absent lumbosacral articular process. A report of three cases and review of the literature. Clin Orthop Relat Res. 1983; 175: 197–201.

[8] Segal D, Franchi AV. Congenital absence of lumbar facets as a cause of lower-back pain. Spine (Phila Pa 1976). 1986; 11(1): 78–80.

[9] Downey EF Jr, Whiddon SM, Brower AC. Computed tomography of congenital absence of posterior elements in the thoracolumbar spine. Spine (Phila Pa 1976). 1986; 11(1): 68–71.

[10] Phillips MR, Keagy RD. Congenital absence of lumbar articular facets with computerized axial tomography documentation. Spine (Phila Pa 1976). 1988; 13(6): 676–678.

[11] Ikeda K, Nakayama Y, Ishii S. Congenital absence of lumbosacral articular process: report of three cases. J Spinal Disord. 1992; 5(2): 232–236.

[12] Kaito T, Kato Y, Sakaura H, Yamamoto K, Hosono N. Congenital absence of a lumbar pedicle presenting with contralateral lumbar radiculopathy. J Spinal Disord Tech. 2005; 18(2): 203–205.

[13] Shim DM, Oh SK. Congenital absence of unilateral lumbar articular process – a case report. Asian Spine J. 2008; 2(2): 106–108.

[14] Yoshioka S, Sairyo K, Sakai T, Yasui N. Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root: a case report. J Orthop Traumatol. 2010; 11(3): 183–187.

[15] Boscherini D, Barbero M, Duc S, Chalaron M. Congenital absence of L4-L5 articular facet joint. Spine J. 2012; 12(12): 1163–1164.

[16] Wang Z, Sakakibara T, Kasai Y. Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra. Neurol Med Chir (Tokyo). 2013; 53(2): 118–121.

[17] Maalouly J, Aouad D, Abd El Nour HG, Nehme A, Jabbour F. Isolated congenital absence of lumbosacral facet joint. Case Rep Orthop. 2019; 2019: 1465460.

[18] Adsul NM, Kumar M, Acharya S, Kalra KL, Chahal RS. Congenital absence of a lumbosacral facet joint: a case report. Surg Neurol Int. 2020; 11: 15.

[19] Tsujimoto Y, Hanakita J, Miyasaka K, Minami M, Takahashi T, Kanematsu R. Unilateral lumbosacral facet abnormality resembling facet interlocking: a case report. NMC Case Rep J. 2023; 10: 51–54.

[20] Vu PD, Bansal V, Malik A, Ryder A, Chen JW. Lancinating lumbar facet syndrome: a congenitally absent facet joint. Pain Manag. 2023; 13: 579–583.

[21] Schellinger D, Wener L, Ragsdale BD, Patronas NJ. Facet joint disorders and their role in the production of back pain and sciatica. Radiographics. 1987; 7(5): 923–944.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.