Facet Joint Syndrome

A joint connects two or more bones in your body and functions to promote motion. In your spine, the joints connecting each of your vertebrae are known as facet joints. Other names for facet joints include zygapophyseal or apophyseal joints, or your doctor may refer to them as simply facets. Like any other joint in your body, each facet joints’ job is to promote healthy movement and—along with the intervertebral disc—provide stability for each motion segment. The disc functions as a spacer and to support motion between the vertebral bodies. This forms a tripod relationship between the intervertebral disc and the facet joint. Degeneration or damage to one affects the other. The effects of aging and/or traumatic injury can damage the facet joints and is the leading cause of back pain known as facet joint syndrome.

facet joint anatomyThe cervical, thoracic and lumbar facet joints allow your neck and back to bend forward and backward and are a common source of spine-related pain. Photo Source: Shutterstock.

The facet joints allow your back and neck to bend forward and backward, but they are also a common cause of spine-related pain. The facet joints located in your lumbar spine (low back) are most susceptible to facet joint syndrome, as the lumbar spine bears the most weight and endures the greatest amount of strain. However, facet joints located in your cervical (neck) and thoracic (midback) spine may also cause chronic pain.

spinal facet jointsThe facet joints allow the spine to move forward (flexion) and backward (extension). Photo Source: SpineUniverse.com.

Facet Joint Syndrome: Common in Low Back, But Possible in Neck and Midback

Low back pain is among the most common medical complaints worldwide—and facet joint syndrome is a common cause of low back pain. The most common site of facet joint pain in the lumbar spine is at the L4-L5 level followed by L5-S1. Some researchers estimate that facet joint syndrome accounts anywhere from 15% of all low back pain complaints to 59.6% in men and 66.7% in women.1

While facet joint syndrome most often affects the lumbar spine, the cervical and thoracic spinal regions may be affected as well. After the low back, the neck is the second most common location of facet joint syndrome, with a prevalence ranging from 30% to 70% of neck pain cases. Due to the articulations (movement) of the ribs with the vertebral body, motion is very limited. In the neck, facet joint syndrome most often occurs at the C4-C5 level.1

The thoracic spine, or midback, is the least likely region of the spine to be affected by facet joint syndrome. The prevalence of facet pain ranges between 33% and 48% of midback pain cases.1

What Causes Facet Joint Syndrome?

The cause of facet joint syndrome is largely dependent on the region of the spine affected. For example, facet pain in the low back is typically caused by the degenerative effects of aging. Like the knee or hip joints, the facet joints are true synovial joints (fluid filled).

As you grow older, the structures that support your spine—such as the intervertebral discs and facet joints—can wear down with years of strain and activity. The interverebral discs are composed primarily of water and age-related degenerative changes affect disc hydration—the net effect being a loss of disc height that separates the vertebral bodies affecting normal alignment of the facet joints. This deterioration and malalignment leads to low back pain. That’s why facet joint syndrome often coexists with other spinal degenerative disorders, including degenerative disc disease, spondylolisthesis, and spondylosis (spinal osteoarthritis).

Cervical and thoracic facet joint syndrome are not as closely associated with aging. Trauma—like whiplash from a car accident—is a common cause of facet joint syndrome in the neck. While aging is the leading cause of facet joint pain in the lumbar spine, trauma from a sports injury or auto accident can cause chronic low back joint pain too. Rarely do spinal tumors affect the facet joints and cause pain.

Facet Joint Syndrome Symptoms Vary

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

Cervical facet joint syndrome
Facet joint syndrome in the neck can produce neck and shoulder pain that can restrict your range of motion, making it difficult to rotate your head comfortably. Facet joint syndrome in the cervical spine may also cause headaches.

Thoracic facet joint syndrome
Thoracic facet joint syndrome can cause pain in your midback, and you may find your range of motion restricted to the point where you find it necessary to turn your entire body to look over to the right or left.

Lumbar facet joint syndrome
Low back pain is commonly caused by facet joint syndrome. You may feel pain in the lower back and sometimes in the buttocks and/or thighs (the pain usually does not go below the knee). Inflammation of these joints can cause stiffness and difficulty standing up straight and getting up out of a chair. Pain with initiating motion is the most prevalent symptom. The condition may cause you to walk in a hunched over position.

How Facet Joint Syndrome is Diagnosed

Seeing a physician knowledgeable in spinal disorders, such as an orthopaedic surgeon, physiatrist, or pain management specialist will help you achieve an accurate diagnosis.

During your meeting with your doctor, he/she will review your medical history and perform a physical and neurological exam. A physical exam includes certain “tests” or physical maneuvers intended to recreate your pain. These may include bending, twisting, or walking. The classic finding on exam is direct pain over the facet joints (low back) with extension. The neurological aspect of your evaluation considers your nervous system and may involve testing your reflexes and other responses.

While the medical history and physical/neurological exam will help rule out the possibility of other conditions, a diagnostic block or injection is necessary to confirm facet joint syndrome. Different types of diagnostic injections exist, including image-guided medial branch blocks and intraarticular injections of local anesthetic.

Diagnostic injections work by sending local anesthetic and/or anti-inflammatory medication to the site of suspected joint pain. If your pain is reduced and mobility restored immediately or shortly after the injection, then that is a strong indication that your doctor has located the source of your pain and can proceed with a targeted treatment plan to address it.

How are Facet Joint Syndrome Symptoms Treated?

Once your doctor confirms your facet joint syndrome diagnosis, he/she will develop a treatment plan that likely uses a combination of nonsurgical treatments. A conservative nonoperative approach is often the starting course of action, and this may include physical therapy and anti-inflammatory medication. Core strengthening exercises (eg, abdominals) and low back stretching are key to alleviate and prevent facet syndrome.

For some people, conservative therapy is enough to manage their spinal joint pain. But if these treatments are not adequately controlling your symptoms, your doctor may move on to minimally invasive nonsurgical therapies. These therapies include medial branch blocks, intraarticular (within a joint) steroid injections, and/or radiofrequency ablation (RFA).

In addition to diagnosing facet joint pain, medial branch blocks and intraarticular injections may be part of your treatment plan. Your doctor will decide which type of injection is best for you.

Intraarticular injections contain pain-relieving anesthetic and steroids that reduce spine pain associated with joint inflammation. On the other hand, medial branch blocks work on the medial branch nerves that arise from the facet joints that carry painful impulses to the brain.

If your pain is relieved by these blocks, it’s a good sign that you’ll also respond well to a nerve therapy with longer-lasting benefits known as radiofrequency ablation (RFA). RFA blocks the nerve’s pain signals by heating the nerves with radiofrequency waves. RFA may be an appropriate treatment if your spinal joint pain isn’t responding well to injection therapy. RFA provides extended pain relief—possibly up to a year.

There are mixed results among the medical community regarding how many medial branch blocks are necessary to move forward with RFA—some experts advocate with two successful blocks while others say a single successful block is enough. Your pain management doctor will work with you and take your specific situation into account as part of his/her recommendation on how and whether to proceed with RFA for your spinal facet joint pain.

Fortunately, these nonsurgical treatments manage most facet joint syndrome cases. In the minority of cases, spine surgery is performed to alleviate pain. The typical surgery for this is a lumbar fusion either performed through an anterior (from the front) or posterior (from the back) minimally invasive approach.

Take Away Points About Facet Joint Syndrome

Facet joint syndrome can cause chronic pain in any region of your spine—from your neck to your low back. Fortunately, diagnostic injections can pinpoint the site of your pain, and your doctor has several nonsurgical and minimally invasive therapies to help manage your pain and restore healthy range of motion.

Updated on: 07/25/19
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