Facet Syndrome

A pair of zygapophyseal joints, commonly known as facet joints, on the posterior (back) aspect of nearly all of the spinal vertebra can become arthritic and painful. These joints function to balance the load of the body in conjunction with the disk at each level, and they also help to control the rotational forces that would otherwise cause disk injury. Years of gravitational loading and injuries lead to development of arthritis (arthrosis), with subsequent loss of joint space cartilage, laxity of the supporting joint capsule, and activation of mechanical pain sensors. Disks often become narrower with aging and degeneration, and this allows the upper vertebral bone to settle lower on the lower vertebral bone, causing greater compressive force on the joint cartilage and bone structure.

This pain can be severe, aching, and throbbing. In the lumbar spine (back) the pain can stay localized to the back and buttock, or may refer down the leg to the foot. In the cervical spine (neck) the pain can stay localized to the neck and shoulder, or may refer down the arm to the hand. The pain is usually worse with extension (arching of the back, or looking toward the ceiling for the neck region) and better with mild to moderate flexion (bending forward a bit). It can be associated with “locking” of the spine especially when the patient moves from a flexed (bent forward) position to neutral. It is usually worse with prolonged sitting and standing, especially on a hard seat or floor. Walking up an incline is often painful, especially in the back but also into the legs at times. The skilled physician will often find localized tenderness over the suspect facet joints with careful examination.

This condition can be painful enough to keep a patient from enjoying many activities. It can easily be confused with spinal stenosis, as there is a great deal of symptom overlap. It can usually be differentiated from stenosis by the use of epidural steroid injections, which tend to help stenosis significantly, and by medial branch block injections, which are commonly helpful for facet syndrome but not particularly for stenosis.

Treatment includes physical therapy to educate the patient in techniques and positions that reduce symptoms, manipulation, decompression therapy/traction, Prolotherapy, and Radiofrequency Neurotomy. Severe cases that respond insufficiently to aggressive non-operative care may require surgical fusion.