FACET JOINT SYNDROME

Questions and Answers.

How Do Facet Joints Protect the Spinal Cord and Cauda Equina?

Facet joints in the lumbar spine play a crucial role in maintaining overall spinal health. These joints not only support the spine’s weight but also facilitate a wide range of movements in both the upper and lower back. But their function doesn’t end there.

Here’s how facet joints protect the spinal cord and cauda equina:

• Structural Support: Facet joints form a strong, interconnected network that supports the vertebrae, ensuring that they stay aligned. This alignment is vital for maintaining the proper position of the spinal cord and cauda equina, safeguarding these critical nerve structures from misalignment-related injuries.
• Movement Control: By acting as hinges, facet joints control and limit the range of motion in the spine. This regulation prevents excessive or unnatural movements, reducing the risk of spinal cord and cauda equina compression or damage.
• Load Distribution: When you lift, twist, or bend, facet joints help distribute the mechanical load evenly across the spine. This balanced load distribution reduces undue stress on the spinal cord and cauda equina, protecting these sensitive areas from direct pressure that could lead to nerve damage.
• Shielding Mechanism: Positioned strategically behind the vertebral discs and in front of the spinal canal, facet joints act as a protective barrier. This placement helps shield the spinal cord and cauda equina from injuries that might occur due to disc herniation or vertebral displacement.

By performing these protective roles, facet joints ensure that the spinal cord and cauda equina remain secure, enabling you to move freely without risking serious injury to these vital nerve structures.

How Facet Joints Provide Support and Prevent Spinal Injuries

The primary functions of the lumbar facet joints are crucial for maintaining spinal health and preventing injuries. Here’s a closer look at how they achieve this:

Allow a considerable range of motion. The lumbar facets enable spinal movements in various directions:

• The shape of the facet joint allows a large amount of flexion (forward bending), up to almost 60°.
• These joints significantly limit twisting movements, protecting the intervertebral discs from rotational injury.
• They also allow limited extension (backward bending).

Absorb loads. The lumbar facets absorb compressive and shear forces placed on the spine, both while standing erect and during spinal movements. This load absorption is vital for minimizing stress on the spine.

• Provide support. Facet joints support the spine by preventing the vertebrae from engaging in movements that can overload and damage surrounding spinal structures such as the discs, spinal nerve roots, and spinal cord.
• Contribute to lumbar proprioception. The nerves that supply the facet joint capsule play a role in lumbar proprioception, which is the body’s ability to perceive its position in space.

By understanding these functions, we better appreciate how facet joints work in tandem with other spinal components to maintain stability and prevent injuries.

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. Also, the facet joints in your cervical (neck) and thoracic (midback) spine can cause chronic pain.

The Basics of Facet Joint Syndrome 

In medical terms, facet joint syndrome is an arthritis-like condition affecting one or more facet joints in the spine. When degenerative changes occur, body weight can unevenly shift, placing more pressure on these joints. This additional pressure leads to:

• Thinning of joint capsules.
• Gradual breakdown of smooth cartilage.
• Development of bone spurs.

As these degenerative changes progress, the affected joints fail to move fluidly, becoming irritated and inflamed. This irritation sends pain signals from the joint’s sensory nerves to the brain, resulting in discomfort, muscle spasms, and stiffness.

Symptoms and Pain Triggers

Facet joint syndrome may remain painless until something triggers the condition. However, the pain can also be chronic. Typically, pain is felt when twisting in the direction of the damaged joint or bending backward. Other common pain triggers include standing or sitting still for extended periods. Conversely, leaning forward, sitting in certain positions, or changing positions may temporarily ease the discomfort.

Pain Distribution

This condition often causes a dull ache over the spine in the lower back, extending to the buttocks. It can also cause pain at the base of the skull and in the shoulders. If bone spurs exert pressure on spinal nerves, the pain may radiate down the legs or arms.

Understanding how facet joint syndrome affects the spine and movement is crucial for identifying effective treatment options. While the condition cannot be reversed, simple home therapies and innovative non-surgical and surgical procedures can help alleviate pain and improve quality of life.

Degeneration of these joints can lead to inflammation and discomfort, significantly impacting your quality of life. When doctors completely understand these contributing factors they can help you take preventive measures to maintain spinal health and mitigate risks associated with facet joint syndrome.

Factors That Increase the Likelihood of Developing Facet Joint Syndrome

Facet joint syndrome is a condition commonly seen in adults, especially those in their later years. Here’s an overview of the key factors that can elevate the risk:

• Age: The likelihood of developing facet joint syndrome increases notably as people age, with a higher prevalence in individuals over 50.
• Physical Trauma: Injuries to the spine, including whiplash from car accidents, can contribute to the onset of the syndrome.
• Genetics: A family history of facet joint syndrome or similar spine conditions can make you more susceptible.
• Posture and Lifestyle: Poor posture, particularly when maintained over long periods, can strain the spine and its joints. Additionally, obesity can amplify the risk due to the increased load on the spinal structure.
• Repetitive Movements: Jobs or activities involving repetitive spinal movements can wear down the facet joints over time.
• Underlying Spine Conditions: Pre-existing conditions like osteoarthritis or degenerative disc disease can also set the stage for facet joint syndrome.

By understanding these factors, you can take proactive steps to mitigate risk, such as maintaining a healthy weight, practicing good posture, and addressing any spine-related injuries promptly.

What Causes Facet Joint Syndrome?

The region of the spine affected determines the cause of facet joint syndrome Facet pain in the lower back, for example, the degenerative effects of aging cause facet joints to develop problems.  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 the joints undergo these changes, they fail to move fluidly, becoming irritated and inflamed. Pain signals travel from the joint’s sensory nerves to the brain, causing discomfort, muscle spasms, and stiffness. Facet joint syndrome may remain painless until triggered, but it can also become chronic. If any of your facet joints are damaged or degenerating, you will typically feel pain when twisting in the direction of the damaged joint or bending backward. Standing or sitting still for prolonged periods can also cause discomfort, while leaning forward or changing positions may temporarily ease the pain.

This spine condition usually causes a dull ache over the lower back, extending to the buttocks, or pain at the base of the skull and shoulders. If bone spurs develop and place pressure on spinal nerves, pain can extend down the legs or arms. Lumbar facet joints are responsible for 14%-41% of lower back pain, making it the most common pain syndrome.

People typically develop facet joint syndrome between the ages of 40 and 70, with a higher prevalence in adults over 50. Risk factors include spine injuries, whiplash, genetics, poor posture, obesity, repetitive movements, and various spine conditions.

Conclusion

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 lower back joint pain. Spinal tumors rarely affect the facet joints and cause pain. When doctors understand these degenerative changes and their effects, they can help manage symptoms and provide appropriate treatment.

Common Signs and Symptoms of Facet Joint Pain

Facet joints are tiny joints that connect vertebral bones. They provide spine stability as well as mobility. Also, facet joints 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.

Understanding Radicular Pain in Facet Joint Disorders

Facet joint disorders often lead to two types of pain: localized pain and radicular pain.

Localized Pain: When pain is confined to the lower back area, it’s termed as localized pain. This discomfort generally doesn’t travel beyond the immediate region of the affected facet joints.

Radicular Pain: Radicular pain, on the other hand, extends beyond the lower back. Here’s how it happens:

• Nerve Root Involvement: The pain travels through a nearby nerve root.
• Leg Impact: As a result, this pain radiates down to the leg.

This form of pain is commonly referred to as sciatica.

Key Points to Remember

• Localized Pain: Stays in the lower back.
• Radicular Pain: Travels down to the leg via nerve roots.

Understanding these distinctions can help in diagnosing and treating facet joint disorders effectively.

Accurately Diagnosing Facet Joint Syndrome

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.

To accurately diagnose facet joint syndrome, your doctor will consider the following factors:

• Your medical history
• Physical exam results
• History of injuries
• Any problems sleeping or standing
• Pain location

If your doctor suspects you may have facet joint syndrome, they may ask you to move or stand in various positions and indicate where you feel pain. They may also feel for tender spots on your spine and work your joints to determine where the damaged facet joints may be located.

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.

Once your doctor has a general idea of where your pain is coming from, they may order imaging studies to support their diagnosis and rule out any other spine-related conditions. An MRI, CT scan, or X-ray provides a clear image of the spine so your physician can locate the damaged facet joints.

Facet Joint Pain Non-Surgical Treatments

Dealing with facet joint syndrome doesn’t mean you’re doomed to a life of chronic back pain. Because Facet Syndrome symptoms frequently mimic other medical conditions, patients should seek a highly trained team of spine specialists for the best care and treatment available. The Southwest Scoliosis and Spine Institute offers various remedies and treatments to help you manage and alleviate pain effectively. By working with spine experts, patients may experience significant relief through nonsurgical treatment methods. These can include:

• Physiatry
• Pain Management
• Physical Therapy

The choice between nonsurgical and surgical treatments depends on your specific condition and pain level. A doctor can help determine the most appropriate treatments and procedures for you to try. Our specialists continue advanced training in diagnosing and treating spine conditions. They believe in treating back pain through an interdisciplinary approach that includes various nonsurgical options and only when necessary – surgery.

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.

Why Proper Posture is Crucial for Managing Facet Joint Syndrome

Proper posture plays a vital role in managing facet joint syndrome because keeping your spine aligned can significantly reduce pain and prevent further damage. When you maintain correct posture, you ensure that your spine isn’t subjected to unnecessary stress, which can exacerbate facet joint issues.

Key Points to Consider:

• Alleviates Pressure: Maintaining a straight spine helps to evenly distribute your body weight, reducing the pressure on your facet joints. This alleviation can lessen the pain and allow for better mobility.
• Prevents Degeneration: Poor posture can lead to misalignment and wear down the facet joints faster. By sitting and standing correctly, you minimize the risk of further joint degeneration.
• Promotes Overall Health: Good posture isn’t just about the spine. It contributes to overall physical health, aiding in proper breathing and circulation. These factors indirectly support spine health by ensuring the muscles around the joints function optimally.

Practical Tips for Better Posture

• At the Desk: Use a chair with a straight back and armrests. Make sure your feet are flat on the floor and your knees are at a right angle. This helps maintain a neutral spine position.
• Sleeping Position: Adjusting your sleeping posture is equally important. Sleep on your back or side with a supportive pillow to keep your spine aligned throughout the night.
• Weight Management: Excess weight increases the load on your spine, worsening pain. Losing weight through a balanced diet and regular exercise can significantly benefit your posture and facet joint health.
• Core Strength: Strengthening your core muscles can provide better support for your spine. Engage in exercises that target your abdominal and back muscles to maintain a stable and well-aligned posture.

By integrating these habits into your daily routine, you can manage facet joint syndrome more effectively, reducing pain and enhancing your quality of life.

Non Surgical Treatments

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. When it comes to alleviating facet joint pain, both prescription and over-the-counter medications play pivotal roles. Here’s a breakdown of common treatments:

Oral Medications

• Acetaminophen: Often recommended for mild to moderate pain, this medication helps patients seeking pain relief.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs, such as ibuprofen and naproxen, help reduce inflammation and pain.
• Muscle Relaxants: These medications ease muscle spasms that may accompany facet joint pain.
• Antidepressants: Certain antidepressants are prescribed to help with chronic pain management, offering relief beyond their primary use.

Topical Medications

For localized pain relief, topical treatments can be highly effective. Available in gels, creams, oils, and patches, these medications can be applied to the lower back or affected area. Tropical medications offer targeted alleviation without systemic side effects. By combining these different types of medications, patients often find a comprehensive approach to managing facet joint pain.

Heat and Cold Therapy

Doctors report that heat and cold therapy can help ease pain caused by facet joint syndrome. Heat boosts circulation, relaxes muscles, and dilates blood vessels, while cold can constrict blood vessels to reduce swelling. When you apply heat, it allows more oxygen and blood to nourish tissues. You can use heat therapy throughout the day or try it when you wake up each day to relieve stiffness and pain.

Cold therapy typically works best when you experience acute pain or have a flare-up. Placing a cold pack on the affected area for no more than 20 minutes at a time can restrict blood vessels to reduce blood flow to numb the pain. Both methods can alter pain sensations, and they can be used together or separately. You can try cold gel packs, heat patches, heating pads, hot water bags, and warm baths to find which method or combination works best for you.

What Are Medial Branch Injections and How Do They Help with Facet Joint Syndrome?

Medial branch injections target the nerves that extend from the dorsal rami of the spinal nerves. These nerves primarily transmit sensory information to the facet joints, which are small stabilizing joints located between and behind adjacent vertebrae.

How Do Medial Branch Injections Work?

The injections help alleviate pain in multiple ways:

• Reducing Nerve Fiber Permeability: By decreasing the permeability of nerve fibers, less blood flows through each nerve, which can help reduce inflammation and discomfort.
• Suppressing Pain Signals: The medication can interfere with the nerve’s ability to send pain signals, thereby reducing the sensation of pain.
• Blocking C Fibers: These fibers are responsible for transmitting pain signals to the brain. By blocking them, the treatment can effectively diminish pain perception.

Procedure

To ensure the injection is administered accurately, doctors use imaging techniques like ultrasound or fluoroscopy. These methods help guide the needle to the precise location, maximizing the effectiveness of the treatment.

Benefits of Facet Joint Syndrome branch injections

Facet joint syndrome often results in chronic back pain due to inflammation or arthritis in the facet joints. Medial branch injections can provide significant relief by addressing the underlying nerve-related issues. This can improve mobility and overall quality of life for those suffering from this condition.

What are Epidural Steroid Facet Injections and How Do They Work?

Epidural steroid facet injections are a medical procedure used to diagnose and manage pain associated with facet joint syndrome. These injections can contain steroids or a combination of steroids and anesthetics.

Diagnostic and Therapeutic Use

When used for diagnostic purposes, the injections help identify specific pain points by including an anesthetic. This anesthetic temporarily numbs targeted facet joints or medial branch nerves, enabling physicians to pinpoint the exact locations causing discomfort.

Mechanism of Action

Facet joints are enveloped by joint capsules lined with synovial membrane tissue. This membrane is susceptible to inflammation, leading to pain. The procedure generally involves:

• Reducing Pain Signals: Steroids in the injections lower the sensitivity of pain receptors, cutting down the pain signals sent to the brain.
• Decreasing Inflammatory Chemicals: The steroids also hinder the production of chemicals responsible for inflammation, thereby easing discomfort.

Treatment Flexibility

For instances where multiple facet joints contribute to pain, physicians may administer multiple injections to address each affected area. The effectiveness of these treatments can vary:

• Short-Term Relief: Some patients may experience pain reduction that lasts a few weeks to a few months.
• Long-Term Relief: Others might find that the injections provide sustained relief or even a complete resolution of pain.

Integration with Physical Therapy

Patients benefiting from short-term relief can often use this time to engage in physical therapy. Working on flexibility and muscle strength during this period may increase the likelihood of achieving long-term pain relief and reduce the frequency of required injections.

By tackling both the immediate pain and the underlying inflammation, epidural steroid facet injections offer a multifaceted approach to managing facet joint syndrome.

Understanding the Risks

While the benefits of this procedure can be significant, it’s crucial to know the potential risks involved:

• Bleeding: Any procedure involving a needle carries a small risk of causing bleeding.
• Infection: As with any medical intervention that breaks the skin, there is a risk of infection.
• Allergic Reaction: Some patients may react to the materials used during the procedure.
• Permanent Nerve or Spinal Cord Damage: Although rare, there is a possibility of lasting damage that could result from complications during the procedure.

Being informed about these risks will help you and your healthcare provider make the best decision about whether to proceed with therapeutic injections for facet joint pain.

Radiofrequency Ablation for Facet Joint Pain Relief

Radiofrequency Ablation (RFA) is a pivotal treatment for those suffering from facet joint pain. 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.

The effectiveness of RFA is rooted in its precise targeting. This injection treatment relieves pain by inducing a heat lesion on the pain-transmitting nerve near the facet. The creation of this lesion is a critical step as it prevents the nerve from sending pain signals to the brain. By interrupting this pathway, RFA provides significant pain relief.

The accuracy of this procedure is enhanced through the use of the diagnostic double-block injection technique. This diagnostic approach ensures that the facet joint pain is accurately pinpointed before treatment, thus maximizing the chances of successful pain alleviation.

Key Takeaways:

• RFA creates a heat lesion that blocks pain signals from reaching the brain.
• The procedure is effective for a prolonged period, generally providing relief for 9 months to over 2 years.
• Diagnostic accuracy is crucial for the success of RFA, typically achieved through the double block injection technique.

By understanding these mechanisms and the careful diagnostic process involved, patients and healthcare providers can better appreciate how RFA offers a targeted and effective solution for managing facet joint pain.

Medical Branch Blocks

Medial branch blocks are a specialized type of nerve block injections that specifically target the medial branches — the pain-transmitting branches — of spinal nerves. By depositing medication around these crucial areas, these blocks effectively obstruct the pain signals before they can reach the brain, offering significant relief to patients.

The nerve ablation procedure, closely related to medial branch blocks, follows a similar initial approach. Once the needle is correctly placed to situate the electrode, a radiofrequency current is utilized to destroy some of the medial branch nerve fibers within the joint that carry pain signals. This method, known as nerve ablation, typically relieves pain for durations ranging from 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, potentially necessitating a repeat procedure.

By using these techniques—medial branch blocks for temporary pain blockage and nerve ablation for longer-lasting relief —patients can experience significant improvements in managing chronic pain conditions. This dual approach allows for tailored treatments that address both immediate and long-term needs, enhancing overall quality of life.

When Are Surgical Options Considered for Facet Joint Syndrome?

When traditional treatments—like physical therapy, medication, or injections—fail to alleviate pain caused by facet joint syndrome, it may be time to explore surgical solutions. Surgery is not a cure for facet joint syndrome, but it can significantly reduce pain and enhance your quality of life. Your healthcare provider will assess your circumstances and may recommend one of the following surgical interventions:

Facet Joint Fusion:

• This procedure involves permanently joining two bones in the spine, stabilizing the affected joint, and reducing pain.

Facet Rhizotomy:

• In this surgery, nerves causing pain in the facet joints are severed or burned, preventing pain signals from reaching the brain.

Laminectomy:

• This operation removes a part of the vertebra, relieving pressure on the spinal cord or nerves.

What to Expect

Deciding to undergo surgery is significant and requires a careful evaluation by your doctor. They will consider the severity of your condition, overall health, and previous treatment outcomes. By opting for the right surgical option, you can find effective relief and return to a more active and comfortable lifestyle.

Is surgery right for you? Consult your doctor to discuss these options and develop a tailored treatment plan.

Surgery

Facet syndrome requires immediate surgery only in extremely rare cases. If the surgeons recommend surgery, it is because conventional treatments failed and the following symptoms still exist:

• Difficulties in standing or walking
• Incapacitating pain

However, it’s essential to recognize when facet joint pain may indicate a more serious underlying condition. Some signs and symptoms to watch for include:

• Pain that suddenly becomes severe and intolerable
• Numbness in the groin and/or genital area
• Severe weakness in both legs
• Retention of urine
• Reduction or complete loss of bowel and/or bladder control

These symptoms may suggest medical emergencies such as tumors, infection, or cauda equina syndrome. If you experience any of these, immediate medical attention and possible surgical intervention are crucial.

Our specialists at the Southwest Scoliosis and Spine Institute continue 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.

Make an Appointment

By exploring the above various treatments and consulting with board-certified professionals, you can find efficient ways to manage and relieve facet joint pain. The doctors at the Southwest Scoliosis and Spine Institute offer a range of solutions tailored to individual needs, helping you regain comfort and improve your quality of life. The Southwest Scoliosis and Spine Institute doctors are well-versed in the options to treat Facet Joint Syndrome.

Our doctors, surgeons, technicians, and staff specialize in complex spinal conditions and have been continually recognized for their excellence.  We can see patients within 24 hours so if you suffer from pain in your back, we invite you to call us for an appointment.  For our patient’s convenience, our doctors see patients in our offices in Dallas, Plano, and Frisco, Texas.  For your information, our board-certified, fellowship-trained surgeons diagnosed and treated more than 100,000 patients. In addition, they successfully performed more than 16,000 surgeries for scoliosis including complicated spine cases and revision surgeries.