FAQ’s on Facet Syndrome
What is facet syndrome?
Facet joints refer to the zygapophyseal joints (Z-joints), which are located at the back of either side of the vertebral column, between the discs and the vertebrae. These are formed by the upper and lower bony outgrowths (processes) and provide support to the spine, especially during rotation. Facet joints assist in keeping the spine stable, preventing each vertebra from slipping over the one below it. These joint surfaces are lined with cartilage to provide a smooth sliding motion.
Facet syndrome refers to back pain caused by these facet joints. This usually presents as: pain that occurs anywhere along the vertebral column and gets progressively worse during the day; pain that is aggravated by standing or by sitting for extended periods of time, or; weakness and numbness. Pain is also aggravated by torsional loads, twisting the back, or lateral bending.
What causes facet syndrome?
Facet syndrome is most commonly caused by degenerative changes from wear and tear. Damage can result from deterioration due to aging, repetitive trauma or injury, or from other progressively worsening conditions such as osteoarthritis or infections. Injuries may also trigger facet syndrome. It has been associated with whiplash injuries, muscle sprains and strains, and acute trauma. Around 55% of facet syndrome cases occur in the cervical (neck) area, while 31% affect the lumbar (lower back) area.
Several other conditions may mimic the presentation of facet syndrome, so it is important to consult your physician if you think you suffer from this condition.
How is facet syndrome diagnosed?
The diagnosis of facet syndrome is made clinically after a complete medical history and physical examination. Laboratory examinations are often not required to establish a diagnosis, but your physician may request additional imaging studies, such as X-rays, Magnetic Resonance Imaging (MRI) scans, and Computerized Tomography (CT) scans to rule out other differentials.
How is facet syndrome treated?
Various treatment modalities have been developed in the treatment of facet syndrome. Conservative management can include physical therapy and rehabilitation. Physical therapy and rehabilitation can break down early scar tissue and restore significant range of motion. Heat therapy and anti-inflammatory medications such as NSAIDs provide relief of symptoms.
In fluoroscopic (X-ray) guided facet joint injections, the physician injects the affected area with anti-inflammatory medications. Ultrasonography-guided injections have also been shown to improve outcomes and provide significant pain relief. Other novel treatments such as radiofrequency treatment have been shown to have promising outcomes. In more severe cases, chemical denervation with alcohol can provide better pain relief and quality of life that repeated neurotomy procedures.
Surgical procedures are considered as a last resort after all conservative measures have been attempted and have failed. The procedure for facet syndrome is cervical fusion; however, it has been noted that pain can still occur after the procedure.
How can I avoid getting facet syndrome?
Prevention of facet syndrome can be easily achieved through lifestyle modifications that address the risk factors. Weight reduction and improved posture have been shown to prevent the development of facet syndrome, and muscle-strengthening exercises can provide additional benefits. Prolonged sitting positions and poor posture should be avoided, as these cause unnecessary pressure on the back.
Joo YC, Park JY, Kim KH. (2013). Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain. Journal of Anesthesia. doi: 10.1007/s00540-012-1525-0
Shabat S, Leitner Y, Bartal G, Folman Y. (2013). Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older. Clinical Interventions in Aging. doi: 10.2147/CIA.S44999
Yun DH, Kim HS, Yoo SD, et al. (2012). Efficacy of ultrasonography-guided injections in patients with facet syndrome of the low lumbar spine. Annals of Rehabilitation Medicine. doi: 10.5535/arm.2012.36.1.66