Facet syndrome is a syndrome in which the

facet joints The facet joints (also zygapophysial joints, zygapophyseal, apophyseal, or Z-joints) are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment and ...

( synovial diarthroses) cause painful symptoms. In conjunction with

degenerative disc disease Degenerative disc disease (DDD) is a medical condition typically brought on by the aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the vertebral column, spine. DDD can take ...

, a distinct but functionally related condition, facet arthropathy is believed to be one of the most common causes of lower back pain.

Signs and symptoms

The symptoms of facet joint arthropathy depend entirely on the location of the degenerated spinal joint, the severity of the damage and the amount of pressure that is being placed on the surrounding structures. It's important to note that the amount of pain a person experiences does not correlate well with the amount of degeneration that has occurred within the joint. Many people experience little or no pain while others, with exactly the same amount of pathology, experience chronic pain. Additionally, in symptomatic facet arthropathy the location of the degenerated joint plays a significant role in the symptoms that are experienced. People with degenerated joints in the upper spine will often feel pain radiating throughout the upper neck and shoulders (cervical facet syndrome.) That said, symptoms often manifest themselves in the lumbar spine, since they are highest here due to the overlying body weight, mobility and geometry. Affected persons usually feel dull pain in the lumbar spine that can radiate into the buttocks and legs. Typically, the pain is worsened by stress on the facet joints, e.g. by lumbar extension and loading (the basis of the Kemp test) or lateral flexion but also by prolonged standing or walking. Pain associated with facet syndrome is often called "

referred pain Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in t ...

" because symptoms do not follow a specific nerve root pattern. This is why patients experiencing symptomatic facet syndrome can feel pain in their shoulders, legs and even manifested in the form of headaches.

Cause

Like many other joints throughout the human body, facets can experience natural degeneration from normal aging. Over time, the cartilage within the joints can naturally begin to wear out, allowing it to become thin or disappear entirely which, in turn, allows the conjoining vertebrae to rub directly against one another with little or no lubricant or separation. A result of this rubbing is often swelling, inflammation causing pain. Over time, the body will naturally respond to the instability within the spine by developing bone spurs, thickened ligaments or even synovial cysts that contact nerve roots exiting the spinal column. While primarily caused through natural wear and tear and degeneration, facet syndrome can also occur as a result of injury to the spine, or lifestyle choices. These causes can include: *

Osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

Spondylolisthesis Spondylolisthesis is when one spinal vertebra slips out of place compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (o ...

Obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

Smoking Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

Malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...

* Trauma such as a car accident, fall or sports injury. * Lack of physical exercise or daily activity (questionably)

Pathophysiology

55% of facet syndrome cases occur in cervical

vertebrae Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spinal ...

, and 31% in lumbar. Spinal osteoarthritis is known as

spondylosis Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense, it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degener ...

. Pathology of the C1-C2 (atlantoaxial) joint, the most mobile of all vertebral segments, accounts for 4% of all

Facet joints

The facet joints are formed by the superior and inferior processes of each vertebra. The

first cervical vertebra In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck. The bone is named for Atlas of Greek mythology, just as Atlas bore the weight of the heavens, the first cervical vertebra suppo ...

has an inferior articulating surface but, as it does not restrict lateral or posterior translation, is not always considered a proper zygoma (''zygoma'' is Greek for "yoke", i.e. something that restrains movement). In the

lumbar spine The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe t ...

, facets provide about 20 percent of the twisting stability in the low back. Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation. Facet joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful

muscle spasm A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ, such as the bladder. A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a musc ...

Diagnosis

Facet arthropathy or 'facet syndrome' can typically be diagnosed through a physical examination,

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

x-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

s and/or a diagnostic block into the suspected joint.

Treatment

In general, anti-inflammatory drugs are prescribed initially. This medical treatment is usually accompanied by

physiotherapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

to increase back and stomach muscles. Thus, the spine can be both relieved and stabilized. If these conservative measures do not bring about betterment, minimally invasive procedures such as a facet infiltration can be conducted to offer relief. In this procedure, a local anesthetic is injected directly into the respective joint, usually in combination with a cortisone preparation (

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

). For long-term relief in more severe cases,

radio-frequency ablation Radiofrequency ablation (RFA), also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, tumor, sensory nerves or a dysfunctional Tissue (biology), tissue is Ablation#Medicine, ablated using ...

or rhyzotomy, where the anterior and posterior spinal nerve root is burnt may be performed.A. Gangi, J. L. Dietemann, R. Mortazavi, D. Pfleger, C. Kauff, C. Roy: ''CT-guided interventional procedures for pain management in the lumbosacral spine.'' In: ''Radiographics.'' 18, 1998, S. 621–633.

References

External links

{{Dorsopathies Vertebral column disorders Syndromes with musculoskeletal abnormalities