What is Facet Joint Syndrome?
The facet joints are connections between the vertebrae of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body. Facet joint syndrome is a condition caused by arthritis and or degenerative changes in these facet joints of the spine. As we age, the cartilage between the facet joint bones starts to degenerate. With less cartilage between those bones, the joint can become inflamed, triggering pain signals in nearby nerve endings. In turn, the muscles in the area can become stiff and spasm.
What causes it?
Like many forms of arthritis, this occurs with age. When we get older, the cartilage between the bones wears down and starts to diminish. As it diminishes, this causes one part of the bone to touch another part of your bone, causing pain.
In addition, degenerative changes in your facet joints can begin with degeneration of your intervertebral disc or the cushion between the bones. When this cushion or “shock absorber” starts to degenerate, the loads of your body weight shifts to your facet joints. This increased shift to your facet joints causes the cartilage in the facet joints to break down quicker leading to “bone on bone” which can cause pain.
What are the symptoms of Facet Joint Syndrome?
Facet joint degeneration can be painless until something causes it to become irritated. There are several symptoms that can indicate your pain may be coming from your facet joints. Generally, there is a diffuse, dull ache in your lower back directly over the spine that can spread to your buttocks. In your neck, it can be felt in your shoulders and back of your skull.
Any movements such as bending backwards or twisting sideways towards the affected joint may cause pain. Any movements that take load and pressure off the facet joints such as sitting, leaning forward, or changing positions may ease the pain. This pain may be chronic or intermittent during flare-ups.
How is Facet Joint Syndrome Diagnosed?
There are many causes of back and neck pain. One cause is facet joint syndrome. Therefore, an accurate diagnosis is important to determine if the facet joints are the source of your pain.
Evaluation will typically involve a medical history where you will tell Dr. Webb what type of pain you are having, what location the pain is at, any history of injuries or trauma, any problems with sleeping, and any aggravating or alleviating factors.
Dr. Webb will then perform a physical exam. During this exam, he will ask you to stand and move in different positions. He will also ask you to point to where you are feeling the pain. Patients with facet joint syndrome usually point to the midline of their back and their pain is usually worse with extending their back backwards.
Lastly, Dr. Webb will go over your imaging studies including X-ray, CT, or MRI with you. This will help him confirm the diagnosis and rule out any other spine or hip related problems that may be causing your pain.
What are the treatments?
While facet joint arthritis can’t be reversed or cured, there is good literature to support exercise,and lifestyle modifications to help contribute to a better quality of life.
Dr. Webb uses a graded treatment regimen, starting with the most conservative treatments first. If level I conservative therapies fail to help manage your pain, then Dr. Webb will likely recommend a diagnostic facet injection next.
This injection is to confirm the facet joint as a cause of your pain.
During this outpatient procedure, the facet joint is injected with a local anesthetic and steroid medication with the use of X-ray fluoroscopy. Fluoroscopy is used to ensure accurate placement of the needle in the facet joint.
Your pain level will be evaluated before the injection, 30 mins after the injection, and over the next few days to weeks. Facet joint involvement is confirmed if your pain level decreases by more than 75%
If your pain level does not change after the injection, it is unlikely that the facet joint is the cause of your back or neck pain. Dr. Webb will then discuss and look into other causes of your pain.
Level I – Conservative Treatments
- Self Care: Working on your core and posture can help keep your spine in alignment, which can help prevent painful episodes. Dr. Webb may make recommendations to your activities of daily living such as standing, sitting, sleep habits, and encourage weight loss. Losing weight can help reduce the increased load and pressure on the facet joints, alleviating pain.
- Physical therapy: this strengthens the muscles in your back and helps your posture to take the load off your facet joints which may help minimize the pain. The physical therapist may also instruct you on proper lifting and walking techniques and work with you on strengthening and stretching your lower back, leg and core muscles.
- Muscle relaxants: this presents the muscles of the low back from having spasms, and thus alleviating some source of the pain
- NSAIDs – these are over the counter pain pills, such as ibuprofen, naproxen, diclofenac, which may relieve some inflammation and reduce pain.
- Chiropractic therapy
- Ice and heat
Level II – Conservative Treatments: Facet Joint Injections
Minimally invasive, outpatient procedure that involves injecting a corticosteroid and analgesic numbing agent into the painful facet joint.
- This is usually done using X-ray
- The pain relief duration is variable from patient to patient. Some patients report relief for only a few days while others report relief for weeks to months.
- If you experience a recurrence of pain, then the injections can be repeated every few months.
Level II – Conservative Treatments: Rhizotomy (Nerve ablation)
- If injections are successful, then you may be a candidate for a rhizotomy or nerve radiofrequency ablation.
- A nerve ablation is a minimally invasive, outpatient procedure that involves burning the small nerves that innervate the painful facet joint.
- First, a diagnostic nerve block test is performed to determine which nerves are being treated. If this block is successful, this tells us that a radiofrequency ablation will likely provide more lasting pain relief.
- Next, a needle is placed near the facet nerve and a radiofrequency current destroys the nerves that carry pain signals. Since the painful facet nerve is destroyed, there should be no more pain coming from the facet bones grinding against each other.
- Pain relief may last from a few months to several years. It is possible that the nerve regrows, necessitating additional nerve ablation procedures.
Level III – Surgery
- Surgery is used when all other conservative treatments have been tried and failed. This usually entails a spinal fusion to eliminate the motion from the painful arthritic joint.