Introduction

The facet joints connect the bones that align to make up the spine. Healthy facet joints glide freely and allow movement. The natural aging process, injury, arthritis, and certain spine conditions can change the way that the facet joints move and lead to pain and restricted motion.  Such symptoms are referred to as facet joint syndrome.

For most people, symptoms of facet joint syndrome are relieved with medications and physical therapy.  A procedure to provide longer lasting results, a radiofrequency neurotomy (radiofrequency rhizotomy), uses heat to “turn off” a nerve and prevent it from conducting pain signals.  Medications, physical therapy, and radiofrequency neurotomy can relieve symptoms of facet joint syndrome and restore pain-free motion so you can resume most of your favorite activities and enjoy a better quality of life.

Anatomy

Your spine is composed of a series of bones called vertebrae.  A healthy spine has three natural front to back curves.  The cervical spine is located in the neck, the thoracic spine is in the upper back, and the lumbar spine forms the curve beneath the waist in the lower back.

With the exception of the first two vertebrae, a pair of facet joints connects each of the bones in the spine.  The facet joints provide stability and allow spine motion

The surfaces of the bones in the facet joints are covered by  cartilage.  The cartilage forms a smooth surface for the bones to glide on during motion.  A membrane called the synovium lines the facet joints.  The synovium secretes a thick liquid called synovial fluid.  The synovial fluid acts as a cushion and lubricant between the bones in the facet joints. The synovial fluid reduces friction between the bones and prevents “wear and tear.

Causes

The natural aging process can cause the bone cartilage to wear away in the facet joints leading to painful bone on bone rubbing and movement restriction. Spine conditions such as arthritis, injury, infection, degeneration, and nerve compression can contribute to facet joint syndrome.

Symptoms

Facet joint syndrome may occur along any part of the spine, but most frequently develops in the cervical spine (neck) or lumbar spine (lower back).  Facet joint syndrome in the cervical spine can cause neck and shoulder pain, stiffness, and headaches. It may be difficult to turn your head, and eventually, you may need to turn your entire body to see from side to side. Your posture may become “hunched over.

Facet joint syndrome in the lumbar spine can cause pain in the lower back, buttocks, and the back of the thighs.  Pain and stiffness may make it difficult for you to stand up or move.  For example, it may be a challenge to rise from a chair.

Diagnosis

Your doctor can diagnose facet joint syndrome by reviewing your medical history, examining your spine, and conducting some tests.  Imaging tests such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans produce pictures to help your doctor identify structural abnormalities.  A facet joint injection (block) may be performed to determine the specific source of your pain.

Treatment

The majority of people with facet joint syndrome achieve symptom relief with medication, activity modification, and physical therapy.  Over-the-counter non-steroidal anti-inflammatory medications can help reduce pain and swelling.  Your doctor may prescribe prescription pain or muscle relaxant medication.

You may be referred to physical therapy to learn correct postures to use while standing, walking, and performing activities.  You may learn new ways of performing activities, such as lifting, to reduce the amount of stress on your back. Exercises can help increase strength and flexibility.

Medication and physical therapy may not successfully relieve symptoms for some people with facet joint syndrome.  After a facet block has confirmed that the facet joint is the source of pain, a radiofrequency neurotomy (radiofrequency rhizotomy) can be used to provide longer lasting pain management.   A radiofrequency neurotomy uses heat to create a lesion in the nerve which impairs its ability to send pain signals.  Because the nerve is “turned off,” pain is not felt.

It usually takes three to four weeks for the treated nerves to completely die.  During this period, your neck or back may feel weak.  You may experience pain until the nerves are dead.

Radiofrequency neurotomy for facet joint syndrome typically provides symptom relief for about a year.  Physical therapy can help you regain strength and flexibility so that you can resume your favorite activities.  If you experience pain again, the treatment may be repeated.

Am I At Risk

Facet joint syndrome occurs most frequently in older adults.  People with spine arthritis or other degenerative spine conditions may be at risk for facet joint syndrome.