Facet Joint Syndrome (Spinal Arthritis)

Facet_SyndromeFacet joint syndrome is a type of spinal arthritis that causes pain at the joint between two spine vertebrae (bones). The 24 vertebrae are stacked one on top of the other, and the space between them is the facet joint. These joints allow the spine to move, bend, and twist. Normally, each facet joint has cartilage, which allows smooth movement, as well as synovial fluid, which lubricates and protects the joint.

With age and wear-and-tear, the facet joint cartilage erodes, and there is a loss of synovial fluid, which creates facet joint syndrome. Low back pain is the most common disorder of the musculoskeletal system and the main reason for disability in people younger than 45 year of age. Facet joint syndrome is the source of back pain in approximately 25% of patients.

Cause of Facet Joint Syndrome

Spinal arthritis can be caused by aging, pressure and overload on the joint, injury, or a combination of all. Degeneration of the intervertebral discs also contribute to facet joint syndrome. The disc lie between each vertebra, and as they lose fluid and break down, the space between the vertebrae narrows. When this occurs, there is too much pressure on the articular cartilage of the facet joints, and the pressure leads to damage and cartilage loss.

When facet joint arthritis worsens, the bones rub together and bone spurs form around the joint area. The spurs take up space in the opening where the nerve roots exit the spine (foramen), which causes pressure on the nerve roots. When the spinal canal narrows from the degeneration and bone spurs, this is called spinal stenosis.

Symptoms of Facet Joint Syndrome

People with facet joint syndrome have a decreased mobility of the spine, which makes twisting and bending difficult. Also, arthritis of the cervical (neck) spine makes it difficult to turn the head. If the spchronic pain pictureinal arthritis affects the lumbar (low back) spine, the individual may have trouble straightening the back or getting up out of a chair. Other symptoms related to nerve root compression (impingement) include:

  • Back pain
  • Numbness
  • Muscle weakness
  • Tingling
  • Weak grasp

Facet Joint Syndrome Treatment

 

  • Epidural steroid injection (ESI) – The doctor uses x-ray guidance (fluoroscopy) to inject a steroid medication into the epidural area of the spine. The fluoroscope allows the doctor to make exact needle placement by viewing the spine on a TV monitor. The corticosteroid medicine provides long-lasting pain relief and decreases inflammation.

 

  • Facet joint injection (FJI) – This procedure is similar to the ESI, but the doctor injects medication directly into the facet joint space. Either one or both an anesthetic and steroid medicine is instilled into the joint to provide pain relief.

 

  • Medial Branch Blocks – this procedure places numbing medicine +/- steroid medication around the facet joints to block sensation to the facet joints through the medial branches. They supply sensation to the joints, and therefore, pain.

 

  • Facet joint denervation – When the patient does well with either a facet injection or medial branch
    Radiofrequency Ablation

    Radiofrequency Ablation

    block and then the pain relief wears off, there are 2 options. One is to have the procedure repeated, and the second is to move on to a facet denervation (radio frequency ablation.) This procedure is carried out similar to the other injections, but the doctor uses phenol or absolute alcohol to deaden and destroy the nerves of the facet joints. Sometimes, radiofrequency energy is passed through the needles to heat the tissue to coagulate and inactivate the nerves.

 

Surgery for Facet Joint Syndrome

When spinal arthritis becomes severe, and the patient does not respond to injections, medications, and other therapies, the doctor may recommend back surgery. Some surgical procedures are:

 

  • Facetectomy – With this procedure, the doctor removes part of the facet (bone structure in the spinal canal). This is done to increase the space so the nerves are not compressed.

 

  • Foraminotomy – The doctor removes the area where the nerve exits the spinal canal (called the foramina). This is also done to increase the size of the nerve pathway.

 

  • Laminectomy – With this procedure, the doctor removes the lamina so the nerves of the spine have more room. This is done to reduce inflammation and irritation.

 

Resources

Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. Mar 2007;106(3):591-614.

Schwarzer AC, Wang SC, O’Driscoll D, et al. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine. Apr 15 1995;20(8):907-12.

Ray CD. Percutaneous Radiofrequency Facet Nerve Blocks: Treatment of the Mechanical Low Back Syndrome. Radionics Procedure Technique Series. Burlington, Mass: Radionics Inc; 1982.