Avascular necrosis of lumbar facet joints associated with bilateral facet fractures

Background contextAvascular necrosis is a commonly described condition caused by a disruption of blood supply to the bones, resulting in necrosis. Although common in joints of the extremities, it is seen less often in the spine. Risk factors for avascular necrosis include steroid use, alcohol consumption, smoking, scuba diving, thrombosis, hypercoagulability, and hypertension.PurposeThe purpose was to report an unprecedented case of avascular necrosis of the lumbar facet joints and bilateral facet fractures.Study designThis is a case report.MethodsThe patient underwent L3–S1 decompression and L5–S1 discectomy, during which time avascular necrosis of the superior articular process of the L3–L4 facet joints was discovered. The patient then underwent spinal fusion with pedicle screw instrumentation. Pathologic examination of both right and left facet joints confirmed the diagnosis of avascular necrosis.ResultsAt 19-month follow up, the patient's leg and back pain had significantly improved. His spine appeared fused with no instability or implant failure.ConclusionWe have presented a case of avascular necrosis of L3–L4 facet joints resulting in fracture and instability at the L3–L4 level of the spine, which was stabilized with an L3–L4 pedicle screw spinal fusion.