back pain treatment

Facet Joint Syndrome

Facet Joint Syndrome

Facet Joint Disease:-

Introduction –
Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms and disability for patients. However, facet joint problems rarely involve the spinal nerves. Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to the joints between the spine bones. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings. Medication, physical therapy, joint injections, nerve blocks, and nerve ablations may be used to manage symptoms. Chronic symptoms may require surgery to fuse the joint.

Anatomy-

These are joints which help the vertebrae, which are the building blocks of the spine to articulate with each other. Each vertebra gives out a superior articulating process and an inferior articulating process which contribute to the joint above and below. These are true synovial joints which are lined by an articular cartilage, have synovial fluid to promote lubrication of the joint surface and are covered by a capsule.

Function-

These joints facilitate movements of the spine like forward flexion and twisting as the articular surfaces glide over each other, but at the same time also contribute to the stability as the joints interlock strongly in certain planes preventing excess movement in that plane e.g.. extension

Nerve Innervation-

Mixed spinal Nerve gives rise to the dorsal rami or the posterior primary division and the ventral rams or anterior primary division. Now the PPD gives rise to lateral and medial branches. These medial branches in turn give rise to ascending and descending branches. The ascending supplies the joint above and the descending branch supplies the joint below

 

  • Causes-

    1. Traumatic degeneration of the facet joints. The primary insult may be motor vehicle accident, fall from height, etc
    2. Age related degeneration of the joints or the mechanical degeneration of the joints. Anyone who lives long enough will definitely have some degenerative changes in the spine. But sometimes it becomes painful needing attention
    3. Occupational hazards – Labourers may face this because of years of carrying heavy weights on their head and shoulders
  • Symptoms-

    Facet joint degeneration can be painless until an event triggers symptoms. There are several symptoms that indicate a person’s pain is coming from the facet joints. The pain is often a diffuse, dull ache in the low back directly over the spine that can spread to the buttocks. In the neck it can be felt in the shoulders and back of the skull.
    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.

  • Diagnosis-

    Imaging Modalities like X rays especially oblique views , CT and MRI can not only point towards the diagnosis of facet joint disease but it also helps in excluding other causes and other red flag signs of the spine

    The most reliable test is an injection of local anaesthetic into the joint or into the nerves supplying the joint. If this does not relieve the pain it is unlikely that the pain is coming from the facet joints.

  • Treatment-

    Conservative:-

    NSAIDs have been used to help during flareups of pain. Other supportive measures like rest, spine strengthening exercises, hydrotherapy and traction can be tried. Osteopathic and Chiropractic manipulations have also seen to help some people to a great extent

    Interventional-

    When these measures do not provide adequate relief, interventional pain management comes into play. Mixture of LA and steroid have been injected around the nerves supplying the joint (well known as medial branch block) or directly into the joint itself. While blocking the nerves usually two- three levels are addressed at once owing to the peculiar nerve supply of these joints.These serve to be diagnostic as well as therapeutic. Blocking the nerves is preferred nowadays to injecting into the joint.

    Regenerative Medicine-

    Some centres are using Prp and stem cells into the facet joint to prvent the progression of arthritis but the efficacy of these procedures has yet to be proven in large scale studies.
    Patients in whom the pain comes back after successful injections can be considered for radiofrequency ablation or rhizotomy of the medial branches supplying the facet joint

  • Surgery-

    Facetectomy and foraminotomy to increase the the dimension of the intervertebral foramen and achieve adequate decompression of the affected nerve root when required
    Finally fusion surgery of two or more vertebrae is carried out to eliminate movement at the affected level hence eliminating the pain producing movement.

  • Prevention-

    Eliminating the cause , for instance a manual labourer with early symptoms may need to have amended duties to prevent the progression
    Excercises to strengthen the spine and increase the mobility . People should be encouraged to take up some physical activity like yoga, pilates, aerobics or athletics whichever suits them.
    Watch your weight.

  • Differential Diagnosis-

    • Sacroiliac joint disease
    • Disc Prolapse/Migration
    • Ankylosing Spondylitis
    • Piriformis syndrome
    • Endometriosis
    • Myofascial Pain
    • Hip Pain

Meet our Doctors