Facet Pain

All About Facet Syndrome

What is Facet Syndrome

The vertebrae of the bony spine are designed to stack together and provide a movable support structure for the body as well as protection for the spinal cord from injury. The spinal cord is the nervous tissue extending from the brain and down the spinal column.

The spinous process is a bony prominence which each vertebrae has, offering protection to the spinal cords nervous tissue. In front of the spinal cord there is also a strong bony body that provides support and weight bearing for all of the tissues above the buttocks. Located on each side of the posterior part of the vertebrae there are facet joints allowing for each vertebra to interact with the vertebra above and below it.

Facet joints labeled

The vertebrae are connected to each other with the facet joint structure. Like the other joints in your body the facet joint has cartilage lining the joint which reduces friction by allowing the bones to smoothly glide over each other. Along with the cartilage there is a capsule surrounding the joint that is lubricated by synovial fluid. Support, stability and mobility for the vertebrae are provided by the facet joints. Just like when a hip or knee becomes arthritic, a facet join can become arthritic and be the source of back pain. When there is degeneration of the facet joint it is termed facet disease, meaning disease or abnormality of the facet joints.

Conditions related to facet joints

  • Facet Arthritis
  • Facet Joint Syndrome
  • Facet Disease
  • Facet Hypertrophy
  • Degenerative Facet Joints

Facet Disease Symptoms

There are many important functions that the lumbar area (often referred to as the low back) provide for the human body. Movement, structural support and the protection of certain body tissues are just a few of these functions.

The lower back supports most of our body’s weight when we are in a standing position and is also involved in movements such as bending over, extending or rotating at the waist. Problems with the lumbar area of the back such as the bony spine, muscles, tendons, and ligaments will often be detected when standing erect or performing any of the movements detailed above.

Facet joints are what allow your spine to be able to bend and flex in a controlled manner. Located on each side of your vertebrae is a facet joint (two per vertebrae). There is a slick covering of articular cartilage on each of these facet joints, similar to the knee and elbow joints, allowing motion without excess friction. Like the other joints in the body, overtime degeneration may occur due to wear and tear.

Facet syndrome

As wear and tear occurs and the cartilage in the facet joint deteriorates the bodies natural healing mechanics will try to compensate for this weakening of the joints by producing osteophytes (bone spurs). These facet joints may also become enlarged over time. Most often back problems will only occur if the enlargement or bone spurs protrude into the spinal canal.

Low back pain that worsens when accompanied by a twisting motion or when extending the lumbar spine is what most people who suffer from facet disease will most often complain about. Unlike the pain and numbness symptoms often associated with a herniated disc or sciatica, the pain is localized and does not radiate down the legs or into the buttocks. Bone spurs will often develop as a facet joint becomes arthritic decreasing the amount of space available for nerve roots exiting the spinal canal. The decreased amount of space adding pressure to the nerve root is often a contributing factor to the development of spinal stenosis. Symptoms of spinal stenosis can be pain, numbness and weakness in the legs and buttocks. Most people suffering from facet disease will state that they cannot twist their torso left or right but have to instead look left or right by turning their entire body. The pain will very rarely be felt in the buttocks or legs, never below the knees and most often the pain is felt in the lower back. Getting out of a seated position or standing straight is difficult because of the stiffness that the inflammation causes.

The majority of people suffering from facet disease will often walk in a hunched over position. A physician that is knowledgeable in spinal disorders will be able to make this diagnosis. Most likely you will be diagnosed by an orthopedic surgeon or a pain management therapist. To confirm the diagnosis usually an injection of local anesthetic along with an anti-inflammatory medication is administered into the affected joints to see if there is any relief of the symptoms. The relief from the pain can be quite dramatic happening almost immediately after completion of the procedure.

Facet Disease Causes

Facet disease causes vary from person to person, but the end result is the same: nerve irritation and back pain. In most cases, the pain is caused by a breakdown or thinning of the cartilage on the facet joint. This can occur naturally with age, but it’s also exacerbated by overuse or a traumatic incident. For others, facet disease occurs because of spondylolithesis. That’s when one vertebra slips out of place and moves forward into another vertebra, pressing on nerves in the process. Fortunately, there are treatment options for both of these facet disease causes.

If spondylolithesis is causing your pain, you doctor will probably ask you to refrain from certain activities to allow the body to heal. Physical therapy, anti-inflammatory drugs, and/or braces may also be used in treatment. If your facet disease is caused by deteriorating cartilage, your doctor will likely recommend a short period of bed rest, traction, anti-inflammatory medications, and/or physical therapy. In both cases, surgical intervention may be used if those methods of treatment are unsuccessful.This is a safe and effective technique that reduces pain by cleaning away damaged tissue in the facet joint while also deadening nerves that transmit pain signals from the site.

Diagnosis of facet disease:

  • Mechanical pain is defined as a specific part of the spine, such as an intervertebral disc, a ligament or a joint that is damaged and not working correctly. Most people suffering from back pain suffer from mechanical pain. 
    Significant lower back pain is rarely caused by facet disease because most patients who suffer from facet disease will often have other conditions contributing to their symptoms. Spinal arthritis, degenerative disc disease and often spinal stenosis will often be the contributing factors to facet disease.
  • When examining a CT scan or a MRI most people with facet joint degeneration will show signs of mild to moderate arthritis in the lumbar area of the spine. To determine whether or not facet disease is a contributing factor to a patient’s back pain a bone scan will be done. A bone scan is a test that shows areas of active inflammation in the patient’s spine.
  • Another way to diagnose facet arthropathy would be to selectively inject facet joints with a mixture of local anesthetic and an anti-inflammatory steroid. Once the injection is complete, if the patients back pain shows significant improvement and there was evidence in the bone scan, MRI, or CT scan of arthritic facet joints, a diagnosis of facet disease can be made with a good deal of confidence.

Facet Disease Treatment

Facet disease treatment will be different from patient to patient, particularly because individuals affected with the condition will experience symptoms differently. Once a patient has been correctly diagnosed with facet disease – a degenerative spine condition that affects the cartilage in the jointed areas of the spine – a doctor can formulate a treatment plan that best meets the patient’s needs. In most cases, treatments begin conservatively.

Conservative Treatments

Conservative facet disease treatment methods are nonsurgical therapies. These methods are widely regarded throughout the mainstream medical community as safe and effective options to reduce a patient’s symptoms, and as such, are typically recommended first. Common treatments include:

  • Bed rest – to help ease discomfort, though bed rest should be kept to a minimum
  • Low-impact exercise – to encourage oxygen- and nutrient-rich blood flow to affected joints
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and pain
  • Narcotic pain medication – to help mitigate moderate to severe pain
  • Physical therapy – to help strengthen the neck, back, and abdominal muscles
  • Cold therapy – to help decrease inflammation and numb pain
  • Heat therapy – to promote blood flow and relax tense or spastic muscles

Alternative Treatments

Common alternative treatments used to combat facet disease symptoms can include:

  • Gentle massage – to help relieve muscle tension and promote blood flow
  • Chiropractic adjustments – to realign dysfunctional joints and relieve pressure on nerves
  • Acupuncture – to relieve discomfort through the ancient Chinese art of inserting hair-thin needles into certain points along the body’s meridians, or channels through which “qi” (pronounced chee) is believed to flow
  • Herbal supplements – to provide a number of different supposed benefits, varying from pain relief to joint lubrication

When These Treatments Fail to Provide Relief

In the event that conservative and/or alternative facet disease treatment methods fail to provide a patient with adequate relief, a doctor may suggest surgery. In the vast majority of cases, several weeks or months of nonsurgical treatments are usually able to reduce symptoms, so surgery typically isn’t necessary.

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