Lumbar Facet Syndrome
 Anatomy & Background

What are Facet Joints?
Each vertebral level of the spine consists of three joints. There is a joint between the bodies of two vertebra connected by an intervertebral disc, and two facet joints, which connect the vertebra. The facet joints are on the posterior aspect of the spine, one on each side. These three joints form a tripod system that provides support, stability and mobility to the spine. In addition to promoting mobility, these joints also function to restrict excessive motion.
The facet joints are synovial joints, which have articular cartilage that covers the ends of the bones. The articular cartilage has a smooth and shiny surface, which allows the ends of the bones to slide freely over each other. In addition, each joint is surrounded by a protective sleeve of soft tissue called a capsule, and is lubricated by synovial fluid. Each joint can be a source of pain if irritated or inflamed
Common conditions of the facet joints include spondylosis, osteoarthritis of the spine, facet joint inflammation, degenerative joint disease of the spine and facet arthropathy.

Facet joint irritation is a common cause of lower back pain. Facet joints, like other synovial joints, are susceptible to wear-and-tear, degeneration, inflammation and arthritic changes. Inflammation and degenerative changes of the facet joints may result in pain, loss of motion, and severe encroachment or pinching of the nerve exiting the spinal column. Common causes of facet joint irritation include:

  • Degeneration, arthritic changes or general wear-and-tear of the joint over time.
  • Disc degeneration may cause a loss of height between vertebra, placing a greater compression force on the posterior facet joints.
  • Backward motions can produce compression on the facet joints which can lead to degenerative and eventual arthritic changes.
  • A sudden fall or trauma, like a motor vehicle accident, can result in a facet joint irritation.
  • Genetic factors can contribute to the likelihood of degenerative joint disease.
  • Repetitive stress injuries such as lifting or carrying heavy loads can cause facet joint irritation.
  • Muscle weakness and poor posture.

When a facet joint is irritated, the symptoms will depend on the location of the facet joint and what soft tissue structures are affected. Symptoms can vary from mild to severe and may mimic the symptoms of a disc problem. Other common symptoms include:

  • Pain in the back or radicular to the buttock into the leg down to behind the knee, but barely in the front of the leg or to the foot.
  • Pain and tenderness localized at the level of the facet joint that is involved.
  • Muscle spasms and changes in posture in response to the injury.
  • Loss of motion, like the inability to bend backward, move sideways to the effected side, stand erect or poor tolerance to sitting.
  • Standing and walking can be difficult if the irritation is severe enough.

Treatment of a facet joint irritation or injury will depend on the severity of the condition. Treatment recommendations can include:

  • Rest. Avoid the activities that produce the pain (bending, lifting, twisting, turning, bending backwards, etc).
  • Anti-inflammatory drugs and other pain medications.
  • Apply ice to the lumbar spine to help reduce pain and associated muscle spasm. Apply ice right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
  • An exercise regiment that is designed specifically to address the cause of the symptoms and facet joint irritation.
  • The use of a brace or other support may be necessary to reduce stress on the facet joints, muscles and lumbar spine.
  • Steroidal medication to reduced inflammation in moderate to severe conditions.
  • Facet Joint injections directly to the involved joint.
  • Physical therapy to reduce inflammation, restore joint function, improve motion, and help return full function.

In mild cases patients found that rest, ice and medication were enough to reduce the pain. Physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

If the problem persists, consult with your health care provider. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

In addition to performing a thorough examination your physician may order the following tests to make a more concise diagnosis:

  • X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infection present.
  • MRI to determine any soft tissue involvement including visualization of the discs, spinal cord and nerve roots.
  • CT scans which can give a cross section view of the spinal structures.

Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasm that may be associated with facet joint injuries.

  • Over the counter medications for mild to moderate pain.
  • If over the counter medications are not effective your physician my prescribe stronger pain medication
  • Anti-inflammatory or prescription NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation following acute injury.
  • Muscle relaxers to reduce acute muscle spasm.
  • Injections such as facet injections, nerve blocks or epidural injections. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

In the case of conditions that do not respond to conservative care surgery may be indicated. If you continue to experience some of the following symptoms:

  • Increase in radiating or radicular pain
  • Pain or nerve irritation that is getting worse
  • Associated disc involvement

Injections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

  • Caudal Epidural Injections
  • Facet Joint Injections
  • Interlaminar Caudal Epidural Steroid Injections
  • Medial Branch Blocks
  • Selective Nerve Root Blocks

  • Endoscopic Decompression
  • Endoscopic Foraminotomy
  • Laser Facet Rhizotomy
  • Facet Thermal Ablation
  • Radiofrequency Ablation

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