Facet Syndrome

Facet Syndrome (FS) is one of the most common causes of spinal osteoarthritis or spondylosis in individuals over the age of 50. Read and find out all about this orthopedic condition, including its types, causes, symptoms, diagnosis and treatment.

Facet syndrome Definition

It is a severe form of back pain that is triggered by the deterioration of the facet joints or zygapophysial joints. A facet joint is a synovial joint that is present between the superior articular process of one vertebra and the inferior articular process of the above vertebra. These bony structures are responsible for connecting one vertebra of the backbone to the other to facilitate movement of the back and neck in different directions. They are sometimes called “points of articulation” between adjacent spinal vertebrae.

The facet joints have cartilages, and synovial fluid that surrounds each joint to cushion it from bone friction. The condition occurs when the synovial lining of these structures undergo acute swelling or inflammation.

Facet syndrome ICD 9 Code

The ICD 9 Code for this disorder is 716.88.

Facet syndrome Types

The condition can be classified into several types, depending on the location of the affected joint in the spine.

Picture of Facet Syndrome

Picture 1 – Facet Syndrome

Lumbar Facet syndrome

This type of FS is associated with inflammation of the facet joints within the lumbar, which constitutes the movable part of the spine or backbone. The major function of the lumbar spine is to bear the entire bodyweight. The five lumbar vertebrae are numbered L1 to L5 and are larger in size. It also provides a small percentage of the twisting ability in the lower back. This form is seen in 31% of all cases of FS.

Cervical Facet syndrome

The form is marked by the deterioration of one or more of the vertebral joints in the cervical region of the spine. About 55% cases of the syndrome occur in the cervical spine that is located inferior to the skull. This particular section of the backbone is responsible for supporting the weight of skull. The seven cervical vertebrae are numbered from C1 to C7. This region has the greatest range of motion, owing to the flexibility of C1 and C2. The pain can turn chronic if left untreated.

Thoracic Facet syndrome

It is not a very common form of the condition. It is usually a result of the regular wear and tear of the thoracic vertebral joints present in the central section of the spinal column. Its main function is to protect the organs inside the ribcage to which it is attached. The thoracic segment also supports the weight of the ribcage. There are 12 thoracic vertebrae that increase in size from T1 through T12. However, the range of motion is limited in this region to ensure stability from the middle of the back. The type is a degenerative condition and develops slowly.

Lumbosacral Facet syndrome

The pain occurs between the lower back and pelvis. It is the most common type of the condition and is degenerative by nature. The lumbosacral spine attaches the iliac or hip bones and protects the pelvic organs like bladder, rectum, uterus and ovaries. The sacral vertebrae are five in number and are normally fused together. The vertebral joints in this region are more prone to damage due to its flexibility as well as the huge pressure encountered while supporting the entire bodyweight.

The syndrome can also be categorized according to the location of damage on the facet joint and include:

Posterior Facet syndrome

In this type, the degeneration of the cartilage occurs towards the rear of the facet joints with or without tenderness. Due to this location, the pain can radiate from the back and move down to the buttocks and into the thighs. It is most often a consequence of the regular aging process.

Lateral Facet syndrome

In this case, the damage occurs on either side of the facet joints. Affected patients may experience sharp pain while bending or moving in the sideward direction. The problem aggravates further when sitting or standing for a prolonged duration in one position.

Facet syndrome Symptoms

The condition is manifested by acute back pain that has a tendency to turn chronic in the absence of proper treatment. Degeneration of the joints may give rise to symptoms like:

  • Intense back pain while bending
  • Frequent episodes of pain in the cervical and lumbar facet joints, that occur on a short-term basis every month or year
  • Neck pain
  • Persistent numbness around the inflamed facet joints
  • Loss of movement and flexibility in the spinal muscle due to involuntary muscular contraction in the presence of a joint pain
  • Radiating pain into the lower and upper back
  • Loss of neck movement
  • Back pain, while sitting or bending towards the affected side
  • Tingling or weakness in the thighs and legs

Facet syndrome Causes

The condition can arise due to continuous abrasion of the cartilage, that eventually results in bone to bone contact. Long-term changes in the facet joints could be associated with the following conditions:

Degenerative disc disorder

The intervertebral discs that lie between adjacent vertebrae in the spine may undergo degeneration, affecting movement of the facet joints. It begins as a chronic back pain and disseminates towards the hips, buttocks or thighs.

Trauma

Excessive movement or pressure on the facet joints may lead to loss of mobility in the spine bones. The condition may occur in case of an accident, sport injury or fall that can cause serious affliction to the backbone. Whiplash or injury to the soft tissues of the neck could be the result of an abnormal motion or force applied to it. The sudden trauma causes movement beyond the normal range of motion of the neck. The series of injuries generate an inflammatory reaction with acute swelling and pain of the facet joints.

Injury to the meniscoid tissue

Meniscoid tissue is a small fold of cartilage present in the facet joint capsule that acts as a cushion between the ends of vertebrae that meet to form the joint. The joint capsule is a small sack that surrounds each joint and lubricates it. In this syndrome, however, these irregularly shaped cartilages get trapped between the surfaces of the joint. This may even lead to nipping or squeezing of the joint capsule. The condition is called meniscoid entrapment that prevents the facet joints from gliding properly, causing pain and swelling.

Development of osteophytes

These are bony projections or bone spurs that form along the joint margins as a repercussion of spinal damage. These spurs later come in contact with adjacent nerve roots, thereby producing intense pain and numbness in the lower region of the body.

In addition to these causes, there are other possible factors like:

  • Poor posture
  • Increase in body weight
  • Family history of facet syndrome
  • Disorders like arthritis or gout
  • Infections

Facet syndrome Diagnosis

An X-ray, MRI or CT scan of the backbone may not aid in identifying the syndrome. However, these imaging tests can help rule out the presence of other conditions that might lead to similar symptoms. In such cases, a detailed and accurate medical history of an affected patient is the most useful tool for performing the diagnosis. The presence of the various signs and symptoms experienced by the patients may also help physicians detect the syndrome.

Facet syndrome Treatment

Non-steroidal anti-inflammatory drugs are generally administered to the affected patients for alleviating the pain and inflammation. Anti-inflammatory corticosteroid is sometimes injected into the facet joint to reduce the symptoms. However, the procedure has to be carried out on a regular basis. Heat or ice packs may provide relief from the back pain and stiffness.

Radiofrequency denervation is a common technique that is used in very severe cases. Here, the nerves that supply the facet joint are destructed by ionizing radiation using a needle-sized probe, which is inserted through a puncture in the skin. The probe has an electrode on its tip, which in turn is connected to a radiofrequency generator that produces a high frequency alternating current to heat the tissues. The procedure, however, does not reverse the syndrome.

Bone fusion surgery may inhibit the associated disc and facet joint problems. The surgery is sometimes performed along with bone graft procedure and bone stimulators. Decompression surgery may require removal of a small portion of the bone, intervertebral disk, or bone spurs. This is done to increase the size of the spinal canal to exit the spinal cord and prevent pinching of the nerve roots to reduce the pain.

Facet syndrome Exercises

There are some exercises that could alleviate the back pain arising due to this syndrome. These involve:

Image of Facet Syndrome

Picture 2 – Facet Syndrome Image

Dynamic stabilization exercises

These exercises target the core posture muscles by keeping the trunk steady while an individual moves one or more of their extremities.

Flexion bias exercises

Physicians recommend these exercises to reduce the force on the posterior facet joints and stretch the ligaments as well as the muscles to support this region. Some of its examples include:

  • Pelvic tilts
  • Bringing the knees to the chest
  • Crunches

Aerobic exercises

Affected patients can go for walking or biking for 20 to 30 minutes a day. Hamstring, knee to chest, hip flexor and piriformis stretch are some stretching exercises for the lower back. Straight leg raises, bridges and wall squats may help in strengthening the lower back.

Facet syndrome is a serious condition and may not respond well to the non-invasive techniques of treatment. However, these methods maintain the flexibility of the facet joint and help in managing the pain. Poor posture plays a predominant role in the development of the syndrome. Affected individuals should always take care of their back posture and regularly perform the exercises recommended by their health care providers.

References:

http://en.wikipedia.org/wiki/Facet_syndrome

http://backandneck.about.com/od/f/g/facet.htm

http://www.painmd.com/types-of-pain/backspine/facet-syndrome.html

http://www.physioroom.com/injuries/back/facet_syndrome_sum.php

 

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