What is facet syndrome?

The words facet syndrome, facet joint syndrome, vertebral joint arthrosis or spondylarthrosis all express the same thing: a degenerative disease of the small spinal joints (facet joints). Osteoarthritis is when the cartilage surfaces of two bones that lie in a joint are affected, damaged or destroyed. The purpose of the articular cartilage is to protect the joint and to provide painless movements. The wear reduces the distance between the individual vertebrae and eventually rubs bone on bone, causing pain. In most cases, the vertebral joints wear out in regions that have to withstand special stresses throughout their lives. It is not a surprise that the degenerative diseases of the vertebral joints are common in the lumbar spine.

Our spine is made up of 33 vertebrae. Each vertebra is in turn composed of a vertebral body and a vertebral arch, which surrounds the spinal cord. The vertebral arches have extensions up and down; two lower processes form the so-called facet joint with the upper processes of the next vertebral arch. This is traversed by pain-sensitive nerve fibers. Between the vertebrae, the discs function as shock absorbers and allow movements of the vertebrae against each other.

If the distance between the vertebrae, that is to say its height, is reduced, the facet joint will no longer function properly and will be misloaded. We then speak of the so-called facet (joint) syndrome. In addition, it comes to irritation by the deposition of calcifications in the joint capsule.

Back pain has a long tradition

At the beginning of the last century, doctors discovered that facet joints could be a possible cause of back pain. In fact, degenerative changes of the spine, facet syndrome included, are actually unavoidable as we get older. In Germany, at the age of 40, one in two residents is affected and almost 60 percent of adults suffer occasionally from arthrosis of the spine.

Back pain causes

Vertebral joint arthrosis is one of the most common and most important causes of back pain. Other causes are reduced distance between the vertebral bodies, especially in the lumbar spine, which are often age-related signs of wear. Previous disc surgery is often seen as a further cause of the facet joint syndrome, because if the discs have a reduced functionality, the strain on the vertebral joints increases. Intervertebral disc and facet joints are closely interrelated due to their function. Damage to one of the two structures usually leads to damage to the other structure. Also, inflammation, cysts and tumors of the vertebral joints can cause the facet syndrome. This can cause severe pain, causing the body to react with an involuntary hardening (tension) of the surrounding muscles.

Even small degenerative changes can lead to severe pain

The severity of pain caused by vertebral joints arthrosis is different and does not necessarily indicate anything specific about the severity of anatomical changes in the spine. In fact, even minimal degenerative changes can cause severe pain, while major signs of wear sometimes cause only a few discomforts. Most patients complain of severe local pain in a limited area of ​​the lumbar, thoracic or cervical spine. If there is a pain, it is usually acute, but it can also be piercing or boring. During the day, the pain often increases because the spine is loaded by the upright gait, while at night it is largely relieved. Back pain usually occurs when bending over, when turning around, when changing position. In addition, hip discomfort may also occur as part of a facet syndrome. Overall, the symptoms of a facet syndrome can lead to severe restrictions on the activities of daily living. Facet pain can also spread in leg or arm.

How to help the doctor with the diagnosis

The diagnosis is made clinically, on the basis of the indicated complaints (pain in the morning, pain during extension and rotation, local pressure pain), the physical and neurological examination. X-rays usually show arthrosis of the vertebral joints, and MRI shows not only arthrosis but also further anatomical changes.

Therapy begins with an important test

The primary therapy is conservative that is to say without surgery. Since the cause of advanced vertebral osteoarthritis cannot be eliminated, pain and physiotherapy are in the foreground. Ideal is a treatment of physiotherapy combined with spinal-friendly sports such as backstroke swimming style, cycling, dancing or Nordic walking. If the conservative methods are no longer effective, the pain in the facet joint syndrome can be controlled by a minimally invasive treatment with a laser called thermal-denervation.

The goal of thermal denervation is to block the transmission of pain reported by nerves within the joint capsule. First of all, a test is performed, that is: through the back, with an injection, a local anesthetic is injected directly into the vertebral joint. With this test, fluoroscopic control, the doctor inserts a needle in the tip of the joint under, where the nerve pulls around the joint capsule and injects a small amount of anesthetic.

After this test, a clear diagnosis can be made. If, after the injection test, there is an improvement in the symptoms and pain, then we are sure that we are facing a facet syndrome. This test is a relative indication but not an absolute one. The denervation itself can be done with the application of heat or cold. Intraoperative nerve stimulation is performed to exclude motor nerve fibers. Then with a laser, which comes through the glass fibers of the needle, is led directly into the affected area. The heat of the laser energy disables the ability of the affected nerves to transmit pain.

The effect of this treatment can last for 1 to 3 years, giving to patients the chance to return to normal life and to participate actively in the therapy exercises. This type of procedure often helps to avoid larger operations. It lasts less than an hour and is performed under general anesthesia via a puncture (no incision) which gives to muscles, bones and ligaments the advantage of not being cut or removed. Because working outside of the spinal canal, the risk of nerve damage is excluded. After just one or two weeks, patients can start physiotherapy to get back-friendly behavior. If there is a severe spinal canal stenosis or herniated disc, then microsurgery would be taken as an option. In case of instability then stabilization can be considered.

Many ways can protect you from the disease

The symptoms of the spinal syndrome can be alleviated and slow the progression of the problem. Although you can only partially prevent osteoarthritis, there are still measures to protect you to a certain degree from the disease, such as back training, weight loss, backstroke swimming style. Please notice: Heavy physical work favors a vertebral disease. In other words, lifting heavy objects massively strains the back and spine, and the vertebral joints wear out faster, especially in the lumbar spine area.

Conclusion: Lead a back-friendly life.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

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