The facet joints are the connections between the bones of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body. These joints also allow the spine to bend and twist, and they keep the back from slipping too far forward or twisting without limits. Like the knee joint, they have cartilage to allow smooth movement where two bones meet. The joints are lined with the synovium and have lubricating joint fluid. When these joints get swollen and painful because of injury or arthritis, it causes pain. If the affected joint is in the neck, it may cause headaches and difficulty moving the head. If it is in the back, it may cause pain in the lower back, buttocks or thighs.
Symptoms may include the following:
- Acute episodes of lumbar and cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year.
- Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding).
- Typically, there will be more discomfort while leaning backward than while leaning forward.
- Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.
- Similarly, cervical facet joint problems may radiate pain locally or into the shoulders or upper back, and rarely radiate in the front or down an arm or into the fingers as a herniated disc might.
When the almost unpredictable painful episodes recur on a monthly basis or more often, a full X-ray should be made and examined. A CT scan can obtain more information about not only the facet joints but also other structures of the spinal segment.
The MRI scan is not quite as useful for diagnosing this particular spinal problem, but is extremely helpful when investigating possible disc or abdominal pain contributors.
Perhaps the most definitive diagnosis of facet joint pain can be made by a facet joint injection with a small volume of a combination of X-ray contrast material, local anesthetic and cortisone. Relief of the acute or chronic problem during the time of action of this combination of drugs is diagnostic.
To break up a cycle of recurring acute facet joint pain, a number of treatments can be used. Many of these treatments give some or even a lot of temporary or long-term relief.
There are a number of nonsurgical treatment options that can be tried to ease the pain and rehabilitate the back including:
- Proper exercise
- Good posture
- Heat or cold therapy
- Frequent rest breaks in daily activities
- Anti-inflammatory, non-steroidal medications
- Chiropractic manipulations
- Restraining collar for the neck or use of supportive pillow
- Facet rhizotomy injection to provide good and temporary relief of the pain
Minimally Invasive Surgical Treatment
In unusually severe and more persistent facet joint pain, minimally invasive bone fusion surgery may be required to stop degeneration of adjoining disc and facet joint problems.
For the majority of patients suffering from facet joint syndrome, surgical treatment is not necessary. A combination of change in lifestyle, maintaining good posture, medication, and proper exercise will reduce the problem to a more manageable level.
Burak Ozgur, MD treats facet joint syndrome with minimally invasive surgical procedures that are designed to help you find relief from pain. Learn more about our minimally invasive procedures or request an appointment for consultation by calling (949) 383-4190 or toll free 888-64-SPINE or Contact Us ➲.