Osteoarthritis (degenerative arthritis) can cause breakdown of cartilage between the facet joints. When the joints move, the lack of the cartilage causes pain as well as loss of motion and stiffness.
The facet joints are located in the back portion (posterior) of the spine. The joints combine with the disc space to create a three-joint complex at each vertebral level. The facet joint consists of two opposing bony surfaces with cartilage between them and a capsule around it. The joint also has fluid lubricating the joint. Each of your spinal bones has two different facet joints. These joints sit on opposite sides of the rear section of the bone and provide connection points for the neighboring vertebrae. These connections help maintain your back’s structural integrity and allow you to make everyday twisting and bending motions. A smooth connective tissue, called cartilage, covers the bone surfaces inside each facet joint. In turn, the entire joint is enclosed in a sleeve-like soft tissue structure called a joint capsule. The interior surface of the joint capsule, called the synovium, secretes a lubricating substance called synovial fluid.
The combination of the cartilage and the fluid allows the joint to move with little friction. However, facet joint arthritis causes the cartilage to breakdown and the joint movement is associated with more friction. The patient loses motion and as they get stiffer they may have back pain.
Typically, the low back pain is most pronounced first thing in the morning. Throughout the day, normal movement causes fluid to build up in the joint and it becomes better lubricated, which decreases the pain. Later in the day the pain typically becomes worse again as more stress is applied across the joint.
People with facet joint syndrome have structural problems that inflame the facet joints and/or degrade their normal function. Potential sources of these problems, which most commonly appear in the neck and lower back, include direct physical trauma, degenerative disc disease, arthritis and certain types of infection. In some cases, inflammation in a facet joint can impinge upon a nearby nerve and trigger a painful condition called a pinched nerve. Pinched nerves are also sometimes classified as a source of facet joint syndrome. Factors that can increase your chances of developing the syndrome include habitual poor posture and advancing age.
The symptoms of facet joint syndrome vary somewhat according to the location of your facet joint problems. The presence of the syndrome in your lower back can produce symptoms that include tenderness near the affected joints and a diffuse or unlocalized pain that appears in your lower back, thighs or buttocks. The presence of the syndrome in your neck can produce tenderness near the affected joints, diffuse pain, headaches and stiffness that makes it difficult to turn your head. People with facet joint syndrome also sometimes have problems standing erect and may have a noticeably stooped posture.
Diagnosis and Treatment
The symptoms of facet joint syndrome can be very similar to symptoms associated with other common types of neck and lower back pain. To make a proper diagnosis of the syndrome, your doctor will perform a procedure called a facet joint injection, which involves the injection of a small amount of anesthetic directly into the suspected joint. If you gain relief from this injection, you have facet joint syndrome. Your doctor can then provide longer-term relief by giving you another injection that contains an anti-inflammatory medication called a steroid (corticosteroid) and a larger dose of anesthetic.
Other potential options for facet joint syndrome treatment include modification of your daily physical activities, physical therapy and use of oral anti-inflammatory medications. People who have severe symptoms or don’t respond to other treatments may need to undergo a surgical procedure called a rhizotomy, which involves the severing of a nearby nerve root.
Conservative treatments that concentrate on maintaining motion in the back are most effective for relieving the pain.
Minimally invasive techniques which can be used include
Facet joint replacement