Facet Joint Syndrome
The adult human spine is made up of 33 bones, or vertebrae. Facet joints connect the vertebrae, and provide for the stability and flexibility of the spine. There are two facet joints between each pair of vertebrae, one on each side. Facet joints link each vertebra to those directly above and below it, and allow the vertebral bodies to rotate with respect to each other. Cartilage in the joints allows for smooth movement where vertebral bones meet, and each is lined with a thin membrane called the synovium, which produces synovial fluid for lubrication.
Sometimes, facet joints may become inflamed, irritated or swollen, causing pain and other uncomfortable symptoms due to the impingement, or “pinching” of the nerves that serve the facet joint. This is called facet joint syndrome.
Potential causes of the condition include inflammation, infection and degeneration of the vertebrae and the discs that cushion and protect them due to aging, trauma and/or poor posture.
The specific symptoms of the condition depend on the location of the affected joint and the nerves that are involved.
- If the affected joint is in the neck, or cervical spine, it may cause localized and/or radiating neck pain and headaches, and it also may be very difficult to turn your head.
- If the affected joint is in the lower back, or lumbar spine, it may cause back pain, pain that radiates into the buttocks and legs, and it may become difficult for you to walk or stand.
To determine whether you have facet joint syndrome, your doctor will examine your back and your medical history, and may order an x-ray, computed tomography (CT) scan of the spine or magnetic resonance imaging (MRI) scan to rule out another disorder as the cause of the pain.
Your doctor also may recommend a non-surgical procedure called a facet joint block. This involves injecting a numbing medicine into or near the nerves that supply the facet joint. If there is a significant decrease in pain after the anesthetic is administered, it is considered a confirmation of facet joint syndrome.
Facet joint syndrome may be treated with a combination of non-surgical therapies designed to relieve both the inflammation and resulting symptoms, including:
- Posture correction — Proper alignment of the spine can reduce stress on the lower back and neck.
- Activity modification — Altering the home and workplace to eliminate excessive twisting, stretching, and bending, as well as learning proper lifting techniques.
- Exercise/physical therapy — To improve flexibility, strength and circulation, as well as reduce pain and inflammation and increase pain-free movement.
- Medication — Over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or, if this fails to provide relief, a prescription pain reliever, steroid or muscle relaxer.
- Facet joint block — In patients for whom it has provided symptom relief during the examination process, a facet joint block also may used as a treatment for facet joint syndrome.
If conservative treatment fails to provide lasting relief, your doctor may recommend spine surgery. Surgical therapies for treating facet joint syndrome include:
- Laminectomy — A procedure in which the lamina of the affected vertebrae (the portion of the vertebral arch that forms the “roof” of the spinal canal) is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.
- Spinal fusion — A surgical technique in which one or more of the vertebrae of the spine are joined together (fused) to stop them from moving against each other. This is done by placing bone grafts or bone graft substitutes between the affected vertebral bone. The graft material acts as a binding medium and also helps to maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.
- Radiofrequency rhizotomy (also called radiofrequency neurotomy) — A procedure that involves destroying the nerves in the facet joints with highly localized heat generated through radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken.
The decision to treat facet joint syndrome surgically requires careful consideration between you and your doctor. Factors to be considered include your specific condition and overall physical health. Discuss your condition thoroughly with your doctor, and rely on his or her judgment regarding which treatment option is most appropriate.