Lumbar Facet Syndrome
The human spine is comprised of a three joint complex. The intervertebral
disc and adjacent vertebral bodies make up the anterior aspect of each
intervertebral segment. Posteriorly, each vertebral segment has two paired facet
joints [Figure 1].
Figure 1: Facet
Joints
The posterior facet joints are just like other joints in your body. They
experience repetitive, constant motion, and thus, they can become worn or torn
[Figure 2]. They also can become restricted in their movement and/or develop too
much movement, which results in pain. The facet joints are shaped and angled
differently in the cervical, thoracic and lumbar spine. This allows for all of
the available motion within the human spine.
Figure 2: Facet
Joints in Motion
Pain that emanates from the facet joints is termed “facet syndrome.” When
suffering from facet syndrome, the facet joints become inflamed and may cause
pain, soreness and/or stiffness. Cervical facet joint pain can be felt in the
areas of the base of the skull, upper back, shoulders, mid-back or neck. Some
patients may present with frequent headaches or even ringing in the ears [Figure
3]. Thoracic facet syndrome is less common than cervical and lumbar facet
syndrome and is probably related to less motion available at these levels due to
the thoracic articulations with the rib cage. Pain experienced in thoracic facet
syndrome is likely to be felt locally near the affected segment near the midline
[Figure 4]. In the lumbar spine, there is more motion available and forces are
higher, thus pain emanating from these joints is quite common. Pain is usually
felt directly over the affected joint(s), but may also be felt in the buttocks,
hips, groin, and back of the thighs depending on which facet joint is injured
[Figure 5].
Figure 3: Cervical Facet Joint Referral Pattern Figure 4: Thoracic Facet Joint Referral Pattern
Figure 5: Lumbar Facet Joint Referral Pattern
In many cases, facet syndrome is caused by trauma, such as a whiplash injury of the neck suffered in a motor vehicle accident. Also, degenerative changes in the cervical, thoracic and lumbar spine can lead to abnormal stress and strain that results in an increased load on the facet joints. Finally, abnormal postures can overload spinal tissues, including the facet joints, and cause inflammation and pain in these joints.
Individuals suffering from facet syndrome may feel worse in the morning, due to increased inflammation and stiffness that occurs during a resting period. They tend to have stiffness and usually will feel somewhat better after they have been moving around. As the day progresses they tend to be ok as long as they keep moving. However, for those having to work seated all day or work from a computer, they may find they are at a greater risk of experiencing pain throughout the day.
Most conservative treatments for facet syndrome involve posture correction, soft-tissue treatments and manipulation of the affected areas. Physical therapists, osteopathic clinicians and/or chiropractors are most adept at getting restricted/painful facet joints to move and reestablish normal motion. Treatments are usually combined with a course of anti-inflammatories to decrease inflammation and muscle relaxers to decrease local muscle spasm. In some cases where the pain is severe, or has become chronic, narcotic medications may be used to decrease pain and suffering. Usually when these types of medicines are needed long term it is best to seek a referral to a pain management specialist.
When more conservative treatments haven’t worked, or if the diagnosis of facet syndrome is still in doubt, intraarticular facet injections and/or medial branch blocks can help localize pain to the facet joints. This can be safely performed using x-ray (i.e. fluoroscopic) guidance. If pain is clearly established to be emanating from a facet joint(s), another form of treatment (that is longer lasting) is to undergo a procedure called medial branch radio frequency ablation.
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