Facet Joint Syndrome
Facet syndrome can occur anywhere in the spine. It develops in the small joints located between each vertebra called facet joints. These joints are in constant motion, providing the spine with both the stability and flexibility needed to walk, run, bend, sit, and twist. The joint surfaces are lined with cartilage allowing them to glide easily over each other. As we age, the cartilage gradually wears away, and in many cases, growths called “bone spurs” can develop. Friction between the bones leads to the tenderness, swelling, stiffness, and pain of arthritis. Though generally the result of the natural aging process, the initial cause of arthritis, or facet syndrome, may be an injury or overuse in youth.
Why it Occurs
Facet Disease is caused by the cartilage in the joints. This type of injury to the spine can be attributed to arthritis of the spine, work, over-use or an accident. Another cause of Facet Disease is spondylolithesis, which is when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.
Primary risk factors: Idiopathic meaning of unknown cause, and senescent or aging: growing old
Secondary risk factors: Trauma; in this case a physical injury, osteonecrosis or temporary or permanent loss of the blood supply to an area of bone, inflammatory arthritis, and dysplasias meaning an abnormal development (of organs or cells) or an abnormal structure resulting from such growth
Other risk factors: Heredity, gender, diet, obesity, age, physical activity.
Pain from facet joint arthritis is usually worse after resting or sleeping. Also, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint. This increases pressure on the facet joints and can cause pain if there is facet joint arthritis.
Pain may be felt in the center of the low back and can spread into one or both buttocks. Sometimes the pain spreads into the thighs, but it rarely goes below the knee. Numbness and tingling, the symptoms of nerve compression, are usually not felt because facet arthritis generally causes only mechanical pain. Mechanical pain comes from abnormal movement in the spine. However, symptoms of nerve compression can sometimes occur at the same time as the facet joint pain. The arthritis can cause bone spurs at the edges of the facet joint. These bone spurs may form in the opening where the nerve root leaves the spinal canal. This opening is called the neural foramen. If the bone spurs rub against the nerve root, the nerve can become inflamed and irritated. This nerve irritation can cause symptoms where the nerve travels. These symptoms may include numbness, tingling, slowed reflexes, and muscle weakness.
Facet joint arthritis is mainly treated nonsurgically. At first, doctors may prescribe a short period of rest, one to two days at most, to calm inflammation and pain. Patients may find added relief by curling up to sleep on a firm mattress or by lying back with their knees bent and supported. These positions take pressure off the facet joints.
Medications and Physical Therapy
Your doctor may prescribe anti-inflammatory medication, such as a nonsteroidal anti-inflammatory drug (NSAID) or aspirin. Muscle relaxants are occasionally used to calm muscles that are in spasm. Oral steroid medicine in tapering dosages may also be prescribed for pain.
Patients often work with a physical therapist. By evaluating a patient’s condition, the therapist can assign positions and exercises to ease symptoms. It gently stretches the low back and takes pressure off the facet joints. The therapist may also prescribe strengthening and aerobic exercises. Strengthening exercises focus on improving the strength and control of the back and abdominal muscles. Aerobic exercises are used to improve heart and lung health and increase endurance in the spinal muscles. Stationary biking offers a good aerobic treatment.
Patients who still have pain after trying various treatments may require injections into the facet joint or the small nerves that go to the joint. An anesthetic is used to block pain coming from the facet joint. A steroid medication is occasionally used instead of the anesthetic. There is no strong evidence that these injections work. However, they seem to have some good short-term results with few side effects. Doctors often have their patients resume physical therapy treatments following an injection. If needed, a longer lasting solution for the joint pain can be to ‘burn the nerves’ of the facet joint. This is called a facet medial branch nerve neurotomy (or rhizotomy) and can be done in the neck or lower back areas with radiofrequency probes providing the heat source. The effects can last up to years and may be repeated if needed.