cartilage covered joints with a synovial lining
(produces joint fluid for lubrication) in the back
of the spine. These joints serve to allow the
spine to bend forward up to 90 degrees and
beyond, extend up to 20 degrees, and rotate to
15 degrees. Pain is produced when the
cartilage of the joint becomes damaged, the
lining producing fluids becomes entrapped,
excessive weight is transferred to the joints,
the joints locked in an abnormal position, there
are bone spurs in or around the joint edges, or
the thick fibrous capsule over the joint torn. In
the lumbar area, this is pain in a band like
distribution, often across both sides of the low
back, worse when standing, walking, and
bending/twisting. Usually the pain is of an
aching quality and sometimes is referred down
the thigh and buttocks. Occasionally, the pain
is referred all the way to the foot, but usually
not into the toes. In the neck, the pain is
usually referred from the neck to the base of
the neck, the shoulders, the shoulder blades,
and the arms but usually not below the elbow.
The facet joint pain in the neck may also
produce headaches over the back of the head.
Facet origin pain is responsible for 15-40%
of low back pain and up to 50% of the pain
from whiplash injuries. It is often seen in
certain clinical situations: osteoarthritis of the
spine, spondylosis, spondylolisthesis, reduced
disc height from disc herniation or from
overzealous discectomy, trauma, etc. Those
who have worked in heavy labor for many years
are more prone to the syndrome. Locking
facets are a peculiar entity which occasionally
occurs when a person bends forward and
literally cannot straighten out the spine. This
is due to an overlap of one side of the facet
joint over its sliding surface.
Diagnosis of facet syndrome is difficult
because often there are multiple sources of
pathology occurring at the same time. CT and
MRI are inaccurate as are plain X-rays and
bone scans. A special type of bone scan called
a spect-bone scan can be useful. The standard
method for diagnosing facet syndrome however
remains the facet block.
The therapy for facet syndrome includes
muscle strengthening exercises, weight loss,
smoking reduction, medications, injections of
the joint (facet injections) and denervation of
the joint via laser, RF, or cryoneurolysis.
