FACET JOINT SYNDROME

Facet Joint Syndrome

A joint connects two or more bones in your body and allows you to move. Facet joints are the joints that connect each of the vertebrae in your spine. Facet joints are also known as zygapophyseal or apophyseal joints, or your doctor may simply refer to them as facets. Each facet joint’s job, like any other joint in your body, provides healthy movement and, along with the intervertebral disc, provides stability for each motion segment. The disc serves as a spacer and supports movement between the vertebral bodies.

The intervertebral disc and the facet joint form a tripod relationship as a result of this. One’s degeneration or damage affects the other. Aging and/or traumatic injury can cause damage to the facet joints, and this constitutes the leading cause of back pain known as facet joint syndrome. Facet joints allow your back and neck to bend forward and backward, but they are also a common source of back pain. The facet joints in your lumbar spine (low back) are the most vulnerable to facet joint syndrome because they bear the most weight and are subject to the most strain. Facet joints in your cervical (neck) and thoracic (midback) spine, on the other hand, can cause chronic pain.

What Causes Facet Joint Syndrome?

The region of the spine affected determines the cause of facet joint syndrome Facet pain in the low back, for example, the degenerative effects of aging cause facet joints to have problems. Facet joints, like knee and hip joints, are fluid-filled synovial joints. With years of strain and activity, the structures that support a spine, such as the intervertebral discs and facet joints, can wear down as you age. The intervertebral discs are primarily composed of water, and age-related degenerative changes affect disc hydration, resulting in a loss of disc height that separates the vertebral bodies, affecting normal facet joint alignment. Low back pain occurs with deterioration and misalignment.

As a result, facet joint syndrome frequently coexists with other degenerative spinal disorders such as degenerative disc disease, spondylolisthesis, and spondylosis (spinal osteoarthritis). Cervical and thoracic facet joint syndrome is less closely related to aging. A common cause of facet joint syndrome in the neck is trauma, such as whiplash from a car accident. While aging is the most common cause of lumbar spine facet joint pain, trauma from a sports injury or car accident can also cause chronic low back joint pain. Spinal tumors rarely affect the facet joints and cause pain.

Facet Joint Pain: Common Signs and Symptoms

Facet joints are tiny joints that connect vertebral bones. They provide spine stability as well as mobility. Facet joints also aid in the development of bony openings through which spinal cord nerves pass the spinal column and travel to other parts of the body, such as the legs and arms.

Facet joints can become inflamed, irritated, or misaligned as a result of an injury or a medical condition such as spondylosis. Because these joints occur in the neck, upper back, and lower back, the signs and symptoms differ depending on the location of the irritated joints. The following describes the most common signs and symptoms of facet joint pain:

• Back stiffness (for example, a person may struggle to turn around while driving to look behind them).
• Pain at the affected facet joint—this pain can feel dull, achy, or even sharp with certain movements.

If swelling and inflammation near the facet joint become severe enough to compress a nearby spinal nerve, a person may experience pain, numbness, tingling, and weakness in an arm or leg.

Accurate Facet Joint Syndrome Diagnosis

The first step in diagnosing facet joint syndrome is to see a spine doctor. The doctor will ask a few questions about the patient’s pain, history of injury, and whether the problem worsens while sleeping or standing. Your doctor may then advise you to move or stand in positions that cause you pain. This enables your doctor to further understand the problem.

A diagnostic facet joint injection may allow your doctor to identify the cause of your pain. This injection contains a corticosteroid as well as a local anesthetic. Your doctor will use X-ray fluoroscopy to ensure that the needle is inserted correctly. You will return home after 20-30 minutes of direct observation. If your pain level decreases by more than 70%, your doctor will conclude that the source of the pain emanates from the facet joint

Facet Joint Pain Treatments

To begin, your doctor will recommend conservative therapies such as self-care, physical therapy, and medications. A wide range of nonsurgical treatments are available, and many are performed concurrently. The following describes Nonsurgical lumbar facet joint pain treatment:

• Heat therapy
• Actively engaging in low-impact exercises.
• Keeping active.
• Giving support for the lumbar curve.
• Making use of a cold pack.
• Using a brace for support.

Self-care

Keeping posture and keeping your spine in alignment are important things you can do to avoid pain as much as possible. This may necessitate a change in your daily standing, sitting, and sleeping habits. Doctors recommend losing weight as one of the most effective ways to reduce stress on facet joints and thus pain.

Therapy for the body

Exercise works effectively in treating facet joint syndrome and can help speed up the healing process, which may seem counterintuitive. Physical therapists can suggest proper lifting techniques as well as proper walking techniques. They will also work with you to strengthen and stretch the muscles in your lower back, legs, and stomach.

Exercises

The results you can expect from the strengthening and stretching exercises they show you, as with any suggested treatment, are directly proportional to your ability to follow them consistently. Pain in the facet joints can make it difficult to work, drive, sleep, or even get dressed in the morning. We strongly advise anyone suffering from facet joint pain or other symptoms to seek professional help from a spine doctor. There are also some exercises you can do on your own to help with daily pain relief while waiting for your doctor’s appointment. The following are some of the best exercises for facet joint pain:

Knee to the chest

Lie down on your back. Tighten your abdominal muscles gently and bring both knees to your chest. Hug your knees gently for 30 to 60 seconds, then relax. You can also try this exercise with only one leg.

Pelvic tilt to the back

Lay on your back, feet flat on the ground, knees bent. Tuck your bottom in and flatten your lower back against the ground. Rep 20 to 30 times more. This is excellent for improving core strength, which is critical for overall spine health!

Walking

Take your phone, a friend, or even your dog for a 10- to 20-minute walk around your neighborhood. Aerobic exercise can help you sleep better, reduce pain, and improve your mood.

Medications

Your doctor may prescribe oral anti-inflammatory medications or topical patches, creams, or salves. If muscle spasms become a problem, your doctor may prescribe muscle relaxants to help prevent them.

Joint injections with steroids

Steroids can help reduce swelling and inflammation in the facet joint nerves. Corticosteroids and an analgesic-numbing agent are injected into the painful joint during this minimally invasive procedure. This can provide pain relief for several days to years.  Steroid joint injections can help improve your condition when combined with physical therapy and exercise. The procedure can be repeated if necessary.

Radiofrequency nerve ablation

If steroid joint injections do not provide long-term pain relief, this procedure, which begins with a diagnostic nerve block test will determine the nerves to treat. Following the completion of the nerve block test, an anesthetic gets injected along the nerve to “block” pain. If that part of the procedure becomes successful, your doctor will proceed with radiofrequency ablation to achieve longer-term pain relief.

The nerve ablation procedure is similar to that of a nerve block. Once the needle is in place to place the electrode, a radiofrequency current is used to destroy some of the medial branch nerve fibers in the joint that carry pain signals. This procedure typically relieves pain for 9 months to more than 2 years. It’s important to remember that there’s always the chance that the nerve will regrow through the burned lesion.

Surgery

The goal of facet syndrome surgery is to attain pain relief, stabilize the spine, and improve mobility. Facet syndrome requires immediate surgery only in extremely rare cases. If the neurosurgeons recommend surgery it is because conventional treatments have failed and the following symptoms still exist

• Difficulties in standing or walking
• Incapacitating Pain

Facet syndrome symptoms frequently mimic other medical conditions, so it is critical to see a highly trained team of spine specialists like those at the Southwest Scoliosis and Spine Institute where spine patients can get the best care and treatment available. Our specialists at the Weill Cornell Medicine Center for Comprehensive Spine Care have advanced training in diagnosing and treating spine conditions. They believe in treating back pain through an interdisciplinary approach that includes physiatry, pain management, physical therapy, and only when necessary – surgery.

Facet Syndrome Minimally Invasive Surgery

Joint injections

Joint injections can reduce inflammation by injecting a numbing solution and a corticosteroid into the facet joint. The relief may be temporary, but it can occur up to three or four times per year. The use of X-ray guidance ensures that the medication is placed correctly in the facet joint.

Nerve ablations/blocks

Radiofrequency ablation employs image guidance to deliver an electric current to destroy the nerve fibers that carry pain signals from the facet joint to the brain. It is frequently performed without the use of general anesthesia.

If conservative treatments such as joint injections and nerve ablations are ineffective, neurosurgeons may recommend minimally invasive spinal surgery. Our spine surgeons have honed their skills in some of the most cutting-edge minimally invasive surgical techniques, which require only small incisions and often take less than an hour. This type of surgery is less traumatic than older surgical methods and requires much less hospitalization.