What exactly is a 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). We speak of osteoarthritis when the cartilage surfaces of two bones, which lie against each other in a joint, are damaged or destroyed.
The task of articular cartilage is to protect the joint and provide for pain-free movement. Wear and tear reduces the distance between vertebrae and eventually causes bone to rub on bone, and that causes pain. Most often, vertebral joints wear out in the regions that must endure particular stresses throughout life. No wonder, that the degenerative disease of the vertebral joints occurs most frequently in the lumbar spine.
Osteoarthritis is extremely widespread. It is considered the most common joint disease. It is responsible for 10 million days of incapacity to work.
When the facet joint no longer works correctly
Our spinal column has 33 vertebrae. Each vertebra is in turn constructed of a vertebral body and a vertebral arch, which encases the spinal cord. The vertebral arches have projections upward and downward. Two lower processes form the so-called facet joint with the upper processes of the next vertebral arch. This is crossed by pain-sensitive nerve fibers. Between the vertebrae, the intervertebral discs act as shock absorbers and allow the vertebrae to move against each other.
If the distance, in other words the height, between the vertebrae is reduced, the facet joint no longer functions correctly and is incorrectly loaded. In this case, we speak of the so-called facet (joint) syndrome. In addition, an irritation condition occurs due to the deposition of calcifications in the joint capsule.
Facet joints as a cause of back pain
Already at the beginning of the last century, doctors discovered facet joints as a possible cause of back pain. In fact, degenerative changes in the spine such as facet syndrome are practically an unavoidable part of getting older. Already at the age of 40, every second inhabitant in Germany is affected. Almost 60 percent of adult Germans suffer from complaints of arthrosis in the spine from time to time
Causes of facet syndrome (vertebral joint arthritis)
Osteoarthritis of the vertebral joints is one of the most common causes of back pain. The causes of a reduced distance between the vertebral bodies, especially in the lumbar spine (LS), are often age-related signs of wear. Another cause of facet joint syndrome is often previous intervertebral disc surgery. When the intervertebral discs have a reduced functional capacity, the load on the vertebral joints increases. The intervertebral disc and facet joints are closely interrelated due to their similar function. Damage to either structure usually results in damage to the other.
Inflammation, cysts and tumors of the vertebral joints can also cause facet syndrome. This can result in severe pain, to which the body reacts with involuntary hardening (tension) of the surrounding muscles.
Symptoms of vertebral joint arthrosis / facet syndrome
The symptoms of vertebral joint arthrosis are varied and do not necessarily say anything concrete about the seriousness of the arthrosis. In fact, minimal degenerative changes can already trigger severe pain, while greater signs of wear and tear sometimes cause only a few discomforts.
Intense local pain
Most often, patients with facet syndrome complain of severe local pain in a limited area of the lumbar spine (LS), thoracic spine (TCS), or cervical spine (CWS). Predominantly, patients suffer from pain in the lumbar spine that may radiate to the legs, buttocks, and groin. When facet syndrome has developed in the neck, there is neck pain that may radiate to the forearms, the back of the head, or the upper back.
When there is pain, it is mostly dull, but it can also be stabbing or drilling. As the day progresses, the pain can often increase because the spine is under constant stress from walking upright, whereas at night it is largely unstressed. In the nocturnal rest position, there is relief of the lumbar spine and cervical spine.
Further or other symptoms of vertebral joint arthrosis: Back pain usually occurs during bending, twisting movements and changes of position. In addition, hip pain may occur as part of a facet syndrome. Leg cramps are also possible with spondyloarthritis. Overall, facet syndrome can cause significant limitations in daily life. Even fever, fatigue and weight loss can indicate spondyloarthritis in the body.
The examination and diagnostics
The diagnosis is made clinically, i.e. on the basis of the stated complaints (pain on starting in the morning, pain on stretching and turning, local pressure pain) and the physical and neurological examination. X-rays usually show osteoarthritis of the vertebral joints, and MRI shows anatomical changes in addition to the osteoarthritis.
The therapy starts with an important test
The primary therapy is conservative, meaning without surgery. Since the cause of advanced vertebral joint arthrosis cannot be eliminated, the focus is on pain therapy and physiotherapy. Ideally, physiotherapy is supplemented with spine-friendly sports such as back swimming, cycling, dancing or Nordic walking.
Blocking pain through thermodenervation
When conservative methods are not (or no longer) effective, pain from facet joint syndrome can be treated with a minimally invasive treatment using a laser (thermodenervation). In the thermodenervation, the goal is to block the pain reported by the nerves in the joint capsule.
Before therapy: test with anesthetic
First, however, a test is performed: To do this, a local anesthetic is first injected directly into the vertebral joint on the back. During a test anesthesia, the doctor guides a needle under fluoroscopic control to the exact spot on the joint where the nerve pulls around the joint capsule. A small amount of anesthetic will then be given.
If there is a marked improvement in symptoms and pain after this test, the diagnosis of facet syndrome is confirmed. Later, sclerotherapy of the small nerves at the joint may be performed. This test is a relative indication and not an absolute indication. Sclerotherapy can take the form of heat or cold application. Intraoperative nerve stimulation is done to rule out motor nerve fibers. Then a laser, which comes through the needle via fiber optics, is directed to the affected area. The heat from the laser energy immobilizes the affected nerve (denervation).
The effect of this treatment can last for 1 to 3 years, allowing patients to return to a normal life and actively participate in therapy through exercise. The procedure saves many from major surgery. It takes less than an hour and is performed under general anesthesia via a puncture (no incision). This has the advantage that no muscles, bones or ligaments are cut or ablated in the process. Because work is performed outside the spinal canal, the risk is extremely low. Patients can start physiotherapy after just one week of rest in order to train themselves to behave in a way that is appropriate for their back. If there is severe spinal canal stenosis or a herniated disc, microsurgery would be an option. If instability is present then we can consider stabilization.
Is a facet syndrome completely curable?
Unfortunately, facet syndrome is not curable. Once vertebral joints are worn out, they cannot be regenerated. But there are good and consistent preventive options, meaning prevention, to enjoy a positive quality of life.
Exercise is something of a magic formula when it comes to being pain free. Find a good physical therapist to help you stabilize your muscles. Strengthened muscles are necessary to prevent spondylolisthesis or facet syndrome. Get detailed but also user-friendly instructions to perform the exercises at home. Your physical therapist needs to get accurate information from you about pain characteristics - for example: Where and when is the pain most severe? Do you suffer from constant pain? Are there triggers that lead to the pain? To what extent does the pain affect your daily life? On this basis, the therapist can put together a suitable movement concept with the right exercises for you.
Occupational disability with facet syndrome?
Patients sometimes ask whether occupational disability is recognized due to facet syndrome, or whether one is entitled to a disability certificate. The answers: An occupational disability could be recognized if the disability makes authoritative activities that are necessary for the profession impossible. So it depends on the profession and specifically your job. A disability certificate is given to people who have a degree of disability (GdB) of 50. A facet syndrome reaches a maximum of 10 on the GdB scale, so you are not considered severely disabled with spondyloarthritis.
There are ways to protect yourself from the disease
The symptoms of vertebral joint syndrome can be reduced and the progression of the problem slowed down. Although you can only prevent osteoarthritis to a limited extent, there are measures that can protect you from the disease to a certain extent, such as back training, weight reduction, and back swimming.
Very important: Heavy physical work promotes vertebral disease. That means - lifting heavy loads puts massive strain on the back and spine, and the vertebral joints wear out faster, especially in the lumbar spine.
Conclusion: Lead a back-friendly life.
Information about the article
The article was last checked and updated on October, 14th, 2022.
About the author
Dr. med. Munther Sabarini, MD, is the director and founder of the Avicenna Clinic. As a specialist neurosurgeon, he particularly has expertise in the treatment of spinal disorders. Dr. Munther Sabarini has more than 30 years of professional experience. During this time he treated more than 30,000 patients.
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Sources and further literature
R. Krämer, et al.: Bandscheibenbedingte Erkrankungen: Ursachen, Diagnose, Behandlung, Vorbeugung, Begutachtung. Deutschland, Thieme, 2013.
J. Jerosch & J. Heisel: Das lumbale Facettensyndrom. Springer-Verlag, 2. Auflage, 2006
M. Glees: Bildgestützte Interventionen beim lumbalen Facettensyndrom. Deutsche Zeitschrift für Akupunktur, Springer Medizin, 03/2018, Deutschland, 2018.
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