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  • The primary indication is to confirm a clinical suspicion of the facet syndrome. Clinical signs include local paraspinal tenderness; pain that is brought about or increased on hyperextension, rotation, and lateral bending; absence of neurologic deficit; absence of root tension signs; and hip, buttock, or back pain when the straight leg is raised [53]. Symptoms of facet syndrome also include cramping leg pain involving the thigh but not radiating below the knee, low back stiffness, and absence of paraesthesia [53]. The back stiffness is typically most marked in the morning [68]. Low back pain is brought about or increased by maintenance of certain positions, such as sitting erect for a long period of time [69]. Focal tenderness over a facet joint is a strong indication in the appropriate settings, besides the presence of signs of paravertebral spasm or deformity in patients, with abnormal facet joints on imaging studies [61]. Cervical facet pain is often characterised by chronic headaches, restricted motion and axial neck pain, which may radiate sub-occipitally to the shoulders or mid-back [70].

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