The facet joints are the small flat joints at the back of the spine. They are the hinges that hold the vertebrae together and allow movement. The spinal nerves exit the spinal column at these joints.
The joints are lined with cartilage making it easier for them to glide over each other. When this cartilage deteriorates the joints may press against the spinal nerves that are exiting through them.
Symptoms and Risks of Facet Joint Syndrome
Risk Factors for Facet Joint Syndrome
- Aging and everyday activity
- Excess weight
- Trauma – sports related or work related that may cause stress or overuse of the joint
- Pain in the upper back or shoulders as the joint presses against the nerves (rarely moves down
- An arm or into the fingers)
- Difficulty bending or twisting your neck
- Pain into the buttocks and down the back of the upper leg (rarely in the front of the leg or further than the knee)
- Difficulty bending or twisting low back
How is Facet Joint Syndrome Diagnosed?
After an examination and a review of your past medical history your spine surgeon or his physician assistant will order x-rays to determine the cause of your pain. An MRI of your spine will be ordered to visualize the vertebra and spinal cord. The MRI alone may not show the facet joint clearly and a CT scan may be ordered. After diagnostic testing is completed your physician will determine your treatment plan.
Treatment Options for Facet Joint Syndrome
Non-surgical treatment options for facet joint syndrome include physical therapy, exercise, medication, chiropractic therapy, massage therapy, acupuncture, and/or application of heat or cold compresses. Occasionally steroids are injected into the facet joint (facet injection) easing the pain and reducing the inflammation.
The steroid injections are done by Orlando Orthopaedic Center’s Pain Management Physicians. This is done in an outpatient surgical suite under fluoroscopy (specialized x-ray machine), which allows the steroid medication to be injected into the facet joint surrounding the nerves that are being affected. This may relieve the pain completely. If the pain is not relieved surgery may be indicated.
When non-surgical treatment fails patients might be a candidate for a facet rhizotomy or bone fusion to remove the damaged facet(s) and stop the motion of the spine alleviating the pain at this location.
Who Should Consider Surgery?
Surgery should be considered for individuals who have failed conservative treatment with medications and injections, or those with symptoms that are so severe that they are starting to lose significant function and are at risk for permanent nerve damage.
All risks and benefits of spine surgery should be considered before making a decision. The spine surgeon will discuss all available options and treatments.