Facet joint syndrome is pain at the joint between two vertebrae in your spine. Another term for facet joint syndrome is osteoarthritis.
The facet joints are the joints in your spine that make your back flexible and enable you to bend and twist. Nerves exit your spinal cord through these joints on their way to other parts of your body.
Healthy facet joints have cartilage, which allows your vertebrae to move smoothly against each other without grinding. Each joint is lubricated with synovial fluid for additional protection against wear and tear.
When your facet joints become swollen and painful due to osteoarthritis, it is called facet joint syndrome.
Facet joint syndrome can be caused by a combination of aging, pressure overload of your facet joints, and injury.
Pressure overload on your facet joints is probably caused by degeneration of the intervertebral discs in your spine. As the discs degenerate, they wear down and begin to collapse.
This narrows the space between each vertebra. This narrowing of the space between each vertebra affects the way your facet joints line up. When this occurs, it places too much pressure on the articular cartilage surface of the facet joint.
The excessive pressure leads to damage of the articular surface and eventually the cartilage begins to wear away.
When facet joint arthritis gets bad enough, the cartilage and fluid that lubricate the facet joints are eventually destroyed as well, leaving bone rubbing on bone.
Bone spurs begin to form around the facet joints. When bone spurs develop, they can take up space in the foramen (the opening between vertebrae where nerve roots exit the spine) and press into nerve roots.
As the bone spurs begin to grow larger, they can eventually extend into the spinal canal itself. This leads to narrowing of your spinal canal, called spinal stenosis.
Patients with facet joint syndrome have difficulty twisting and bending their spine. If you have facet joint syndrome in your cervical spine (your neck), you may have to turn your entire body to look left or right.
Facet joint syndrome in your lumbar spine (low back) may make it difficult for you to straighten your back or get up out of a chair.
Pain, numbness, and muscle weakness associated with facet joint syndrome will affect different parts of your body depending on which of your nerves are being affected.
If the nerves affected are in your cervical spine, you may have symptoms in your neck, shoulders, arms and hands. If the nerves are in your lumbar spine you may have symptoms in your buttocks, legs, and feet.
A correct diagnosis must await subsidence of the acute problem. Symptoms may include the following:
Acute episodes of lumbar and cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year.
Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding).
Typically, there will be more discomfort while leaning backward than while leaning forward.Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg.
The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.
Similarly, cervical facet joint problems may radiate pain locally or into the shoulders or upper back, and rarely radiate in the front or down an arm or into the fingers as a herniated disc might.
Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. Patients are often left with the notion that this is a psychosomatic problem, and it may even be implied that “it’s all in your head.”
In the lumbar case, standing may be somewhat limited but sitting and riding in a car is the worst. So-called “limited duty” (sitting) assignments for patients with low back pain are paradoxically bad.
When at its height of pain and disability, the muscle spasm is so continual that it fatigues the muscles, which in turn, repeats the cycle.
The diagnosis of facet joint syndrome usually begins with a complete history and physical exam. Your doctor may order other diagnostic tests as well.
X-rays may be recommended to determine whether there are abnormalities in your spine.
A CT scan can sometimes show more detail about your facet joint surfaces. If the X-rays suggest something may be affecting your facet joints, your doctor may recommend a CT scan to get a better look.
A bone scan can be useful in determining whether your facet joints are inflamed. An inflamed facet joint usually shows up as a hot spot on a bone scan.
When the almost unpredictable painful episodes recur on a monthly basis or more often, plain anterior-posterior (front-back), lateral (side view), and oblique (off angle) X-ray films should be made and examined. Usually the abnormal facet changes can be seen.
However, a CT scan can obtain more information about not only the facet joints but also other structures of the spinal segment.
The MRI scan is not quite as useful for diagnosing this particular spinal problem, but is extremely helpful when investigating possible disc or abdominal pain contributors.
Perhaps the most definitive diagnosis of facet joint pain can be made by a facet joint injection (or facet joint block), which injects the suspicious facet joints with a small volume of a combination of X-ray contrast material, local anesthetic, and cortisone.
Relief of the acute or chronic problem during the time of action of this combination of drugs is diagnostic.
Your doctor may also recommend that you undergo a fluoroscopic injection into your facet joint. During this test, a local anesthetic is injected into the joint.
The doctor uses a fluoroscope to make sure the needle is actually in the joint before injecting the medication.
Your facet joints are located fairly deep in the upper buttocks and are covered by thick muscle. It is difficult to put a needle into the joint without some guidance.
A fluoroscope is a special TV camera that uses X-rays to allow the doctor to see on the screen the exact placement of the needle and to make sure it is positioned accurately.
Once the needle is in the right place, anesthetic is injected to numb your joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from the facet joint that was injected and not somewhere else in your spine.
The doctor may also add a dose of cortisone to the injection to help ease your pain. Cortisone is a powerful anti-inflammatory medication that calms the arthritis inside the joint and reduces pain.
The effect is usually temporary, but it may last up to several months.
Once a diagnosis of facet joint syndrome has been confirmed, your doctor will likely recommend physical therapy to treat your symptoms.
A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Physical therapy may also include the use of ice to decrease blood flow to the affected area and reduce swelling.
Ultrasound and electrostimulation may also be used to treat muscle spasms. Massage and muscle stretching may also be helpful.
When you’re feeling better, exercises will help you regain joint mobility, flexibility, and strength.
An injection into your facet joint using cortisone can be helpful for calming pain and inflammation. The injection usually gives temporary relief for several weeks or months.
Surgery may become an option if all conservative methods of treatment fail. Surgery on the facet joint usually consists of a fusion of the joint (also called an “arthrodesis”). To join the two vertebrae together, the doctor will usually insert several metal screws across the joint.
Bone graft may also be placed around the joint to help fuse it. The bone graft is usually removed from your pelvic bone right beside the SI joint.
In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require a bone fusion surgery to stop both the associated disc and facet joint problems.
Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.
Fortunately, for the vast majority of patients, a combination of change in lifestyle, medication, and proper exercise and posture will reduce the problem to a manageable level.