Facet Joint Syndrome
Anatomy of facet joints
• Vertebral body-the bony building blocks of the spine
• Facet joint-small stabilizing joints located between and behind adjacent vertebrae
• Intervertebral disc-which provides a cushion between each of the vertebral bodies and binds them together
To prevent excessive motion, over-twisting or toppling over, the segments of the spine are stabilized by a number of structures that nonetheless preserve the flexibility needed to turn, look around and get around. The facet joints, or joints with “small faces” are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back. The vertebrae of the chest area are normally far less mobile and permit a small amount of forward/backward and some side bending, and very little twisting.
At each given spinal level the angle of the facets - relative to a plane running through the body from front to back - varies from more parallel to more perpendicular. Each facet joint is positioned at each level to provide the needed limits to motion, especially to rotation and to prevent forward slipping (spondylolisthesis) of that vertebra over the one below.
Each upper half of the paired facet joints are attached on both sides on the backside of each vertebra, near its side limits, then extend downward. These faces project forward or towards the side. The other halves of the joints arise on the vertebra below then project upwards, facing backward or towards the midline to engage the downward faces of the upper facet halves.
The facet joints do slide on each other and both sliding surfaces are normally coated by a very low friction, moist cartilage. A small sack or capsule surrounds each facet joint and provides a sticky lubricant for the joint. Each sack has a rich supply of tiny nerve fibers that provide a warning when irritated.
The intervertebral discs are also a type of joint in the spine, and are bound together by flexible fibers in several circling bands, like a tough fire hose, that make up the outer portion of the disc. Disc joints can bend and rotate a bit but do not slide as do most body joints.
Facet joint problems – back pain from bone spurs and osteoarthritis
Back conditions that may be confused with facet joint problems
Symptoms of facet joint problems
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 continuous that the fatigued muscles begin to hurt themselves and a vicious cycle begins.
Diagnosis of facet joint problems
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.
To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help.
There are a number of conservative care treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:
Fortunately, for the vast majority of patients, a combination of change in life style, proper exercise and posture will reduce the problem to a manageable level.