Chandler Chiropractic, Acupuncture & Non Surgical Spinal Decompression

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GLOSSARY of TERMS

Facet Joint Syndrome

Anatomy of facet joints
Nearly every flexible or movable level of the spine (with the exception of the very top vertebra) is comprised of the same elements, including:

• Vertebral body-the bony building blocks of the spine

• Facet joint-small stabilizing joints located between and behind adjacent vertebrae

• Intervertebral disc-which provides a cushion between each of the vertebral bodies and binds them together

To prevent excessive motion, over-twisting or toppling over, the segments of the spine are stabilized by a number of structures that nonetheless preserve the flexibility needed to turn, look around and get around. The facet joints, or joints with “small faces” are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back. The vertebrae of the chest area are normally far less mobile and permit a small amount of forward/backward and some side bending, and very little twisting.

At each given spinal level the angle of the facets - relative to a plane running through the body from front to back - varies from more parallel to more perpendicular. Each facet joint is positioned at each level to provide the needed limits to motion, especially to rotation and to prevent forward slipping (spondylolisthesis) of that vertebra over the one below.

Each upper half of the paired facet joints are attached on both sides on the backside of each vertebra, near its side limits, then extend downward. These faces project forward or towards the side. The other halves of the joints arise on the vertebra below then project upwards, facing backward or towards the midline to engage the downward faces of the upper facet halves.

The facet joints do slide on each other and both sliding surfaces are normally coated by a very low friction, moist cartilage. A small sack or capsule surrounds each facet joint and provides a sticky lubricant for the joint. Each sack has a rich supply of tiny nerve fibers that provide a warning when irritated.

The intervertebral discs are also a type of joint in the spine, and are bound together by flexible fibers in several circling bands, like a tough fire hose, that make up the outer portion of the disc. Disc joints can bend and rotate a bit but do not slide as do most body joints.

Facet joint problems – back pain from bone spurs and osteoarthritis
Facet joints are in almost constant motion with the spine and quite commonly simply wear out or become degenerated in many patients. When facet joints become worn or torn the cartilage may become thin or disappear and there may be a reaction of the bone of the joint underneath producing overgrowth of bone spurs and an enlargement of the joints. The joint is then said to have arthritic (literally, joint inflammation-degeneration) changes, or osteoarthritis, that can produce considerable back pain on motion. This condition may also be referred to as “facet joint disease” or “facet joint syndrome”.

Back conditions that may be confused with facet joint problems
Interestingly, when the acute lumbar or cervical facet joint inflammation is at its peak, the symptoms may closely imitate those of a herniated disc, a deep infection, a fracture or a torn muscle of the spine, or in the low back, sometimes an acute intra-abdominal problem. Clearly, such episodes can be very disabling and frightening.

Symptoms of facet joint problems
A correct diagnosis must await subsidence of the acute problem. Symptoms may include the following:

• 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).

• There will typically be more discomfort on slightly leaning backwards than on leaning forwards.

• 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.

Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. Patients are often left with the notion that this is a psychosomatic problem, and it may even be implied that “it’s all in your head.”

In the lumbar case, standing may be somewhat limited but sitting and riding in a car is the worst. So-called “limited duty” (sitting) assignments for patients with low back pain are paradoxically bad. When at its height of pain and disability, the muscle spasm is so continuous that the fatigued muscles begin to hurt themselves and a vicious cycle begins.

Diagnosis of facet joint problems
When the almost unpredictable painful episodes recur on a monthly basis or more often, plain anterior-posterior (front-back), lateral (side view) and oblique (off angle) X-ray films should be made and examined. Usually the abnormal facet changes can be seen. However, a CT scan can obtain more information about not only the facet joints but also other structures of the spinal segment.

The MRI scan is not quite as useful for diagnosing this particular spinal problem, but is extremely helpful when investigating possible disc or abdominal pain contributors.

Perhaps the most definitive diagnosis of facet joint pain can be made by a facet joint injection (or facet joint block), which injects the suspicious facet joints with a small volume of a combination of x-ray contrast material, local anesthetic and cortisone. Relief of the acute or chronic problem during the time of action of this combination of drugs is diagnostic.

To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help.

There are a number of conservative care treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:

• Successful long-term treatment involves proper exercises, with instruction by a trained chiropractor or other healthcare provider.

• Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase). A very useful posture when standing or sitting is the pelvic tilt - where one pinches together the buttocks and rotates forward the lower pelvis - and holding that position for several seconds, done several times per day.

• Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes

• Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks

• The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAID’s (e.g. ibuprofen) and the more recent Cox-2 inhibitors (e.g. Celebrex)

• Chiropractic manipulations may provide pain relief.

• For the neck, a restraining collar may bring temporary relief, as may also cervical traction. A suitable supportive neck pillow is often essential and abnormal nighttime flexion positioning of the neck, such as when using a pile of pillows, is to be avoided.

Fortunately, for the vast majority of patients, a combination of change in life style,  proper exercise and posture will reduce the problem to a manageable level.