Facet Syndrome

What Is Facet Syndrome?

Back or neck pain caused by damaged spinal facet joints is known as facet joint syndrome. These joints can also be called zygapophyseal or apophyseal joints, and are classified as synovial joints (fluid filled) like the knee. Two facet joints connect each of your vertebrae to help allow for motion, and with your intervertebral discs provide stability for each vertebral segment. The two facet joints and your intervertebral disc form a three prong joint, and degeneration or damage to one affects the other two. Damage can be caused from the effects of aging and/or trauma.The lumbar (low back) facet joints are most susceptible to facet joint syndrome due to bearing the most weight and experiencing significant strain. The cervical (neck) facet joints are the second most common locations producing facet joint pain. The thoracic (midback) is the least likely location of the three.

What Are The Symptoms for Facet Joint Syndrome?

Facet joint pain produces different symptoms based on the spinal region affected.

Cervical Facet Joint Syndrome

Neck and shoulder pain that can restrict your range of motion, making it difficult to rotate your head comfortably, and cervical facet joint syndrome may also cause headaches.

Thoracic Facet Joint Syndrome

Can cause pain in your mid-back and restrict your range of motion while turning.

Lumbar Facet Joint Syndrome

Low back pain that can radiate into the buttocks and/or thighs (the pain usually does not go below the knee). Inflammation of these joints can lead to stiffness, difficulty standing up straight (causing you to walk hunched over) and getting up out of a chair. Pain with initiating motion is the most prevalent symptom.

What Are The Causes Of Facet Joint Syndrome?

The lumbar facet joints and intervertebral discs experience wear and tear as you age which may place excessive stress on the three pronged joint. Loss of disc height from intervertebral disc degeneration causes malalignment and stress on the facet joints leading to inflammation, arthritis and back pain. This condition often coexists with other spinal degenerative disorders, including degenerative disc disease, spondylolisthesis, and spondylosis (osteoarthritis).Cervical and thoracic facet joint syndrome are not as closely associated with aging as lumbar facet joint syndrome. Trauma, such as whiplash from a car accident, is a common cause of facet joint syndrome in the neck. Rarely, spinal tumors affect the facet joints and cause pain.

Diagnosis

A thorough history and physical examination with your pain management doctor is important to obtaining a diagnosis.Imaging, such as x-ray, CT or MRI scans can help support the suspected diagnosis of facet joint syndrome.A diagnostic block or injection is necessary to confirm the diagnosis. These include fluoroscopically (x-ray) guided medial branch blocks or intraarticular facet joint injections with local anesthetic.If your pain is reduced by more than 80% and your mobility is restored soon after the injection, and lasts for a couple of hours, then your doctor can proceed with a more definitive treatment.

What Are The Treatments?

Non-Surgical Treatment

Medications:

Nonsteroidal anti-inflammatory drugs (ibuprofen, Advil, Aleve, meloxicam, Mobic, naproxen, etc) can help reduce pain and inflammation.Physical therapy and exercise. Your doctor may recommend physical therapy to learn specific exercises to help strengthen and stabilize your core (abdominal and back muscles), as well as low back stretching.

Interventional Procedures

Medial branch blocks.

Intra-articular steroid injections.

Radiofrequency ablation (RFA).

Spinal cord stimulation.

Intrathecal drug delivery system.

Surgical

In the minority of cases, spine surgery (anterior or posterior fusion) is performed to alleviate pain.