Expert Consensus-Based Criteria for Identifying Lumbar Facet Joint Pain in Primary Care: Development Using Factor Analysis and a Modified Delphi Method.

introductionLumbar facet joint pain is a treatable condition often overlooked or misclassified as nonspecific low back pain. Although facet joint blocks are useful for diagnosis, they are unsuitable for early-stage screening. This study aimed to develop practical diagnostic criteria for lumbar facet joint pain that are easily applicable by general practitioners without invasive procedures to facilitate early identification and referral for appropriate treatment.

methodsPubMed was searched for articles on facet joint pain. All diagnostic items described in the identified articles were comprehensively collected. A questionnaire survey was administered to orthopedic spine surgeons, who rated each item based on its diagnostic value; only those considered important were extracted. Next, using factor analysis, the items were grouped into a small number of factors. Diagnostic criteria were then established through multiple Delphi rounds.

resultsThe query identified 2682 articles published between 2000 and 2023; eight articles were used to extract 77 diagnostic items. A survey collected responses from 39 orthopedic spine surgeons. The 25 most important items were selected from the survey results, and factor analysis was applied. Through multiple Delphi rounds, four diagnostic criteria were established: physical findings suggesting facet joint pain, neurological symptoms, imaging findings suggesting non-facet causes, and signs of discogenic low back pain. Diagnosis is confirmed if the first criterion is met and no more than one of the others is present.

conclusionConsensus-based diagnostic criteria for lumbar facet joint pain were developed, which offer a noninvasive, clinically practical approach to diagnosis, promoting early recognition and appropriate referral by general practitioners.