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Zygapophyseal (Facet) Joint Syndrome: What All Back Pain Patients Need To Know

October 10, 2017

What is "Facet Syndrome"?

Facet joint syndrome is spinal pain that originates in the joints on the back side of each of the vertebra. These joints are designed to help stabilize the spine as it moves. There are two such joints at each spinal level. Working in unison the joints assist in making it possible for your back to be more flexible and they support and stabilize the spine as it flexes, extends, and rotates.

What causes facet joint pain?

Causes. Facet joint syndrome can be caused by a combination of aging, pressure overload of the facet joints, injury, and/or trauma. As the lumbar discs degenerate, they wear down and begin to collapse.  This degeneration causes the approximation of the facet joints and more weight and pressure is placed on the joints.

What does facet sclerosis mean?

Facet sclerosis is another term for the degeneration of the joints. It is usually referred to in this way to describe the appearance of the generated joints on x-ray images.

What is facet joint tropism?

Facet joint tropism is a difference in shape or size of the facet on one side of the spine when compared with that on the other side. Facet tropism may also describe differences in angulation of the facet joints. Overall, the word tropism describes an asymmetry of a facet joint on one side of the spine compared with the other. facet tropism can occur at one level or several levels of the spine. This condition is not uncommon.  Estimates of the exact frequency of this condition vary widely. However, most experts agree that the incidence is somewhere around one in six people. Some estimates, however, estimate the incidence of facet tropism as high as 70%. Many experts believe that the presence of asymmetry or tropism in the facets had a spinal level increases the likelihood of irregular wear and degeneration at that level.

What are the symptoms of arthritis in the lower back?

There are several different types of arthritis and arthritis can present in several different ways in the lumbar spine, also known as the low back. The most common type of arthritis is osteoarthritis or arthritis that comes from normal wear and tear over time as part of the normal aging process. This is degenerative arthritis as opposed to inflammatory arthritis such as rheumatoid arthritis. Osteoarthritis usually presents as a goal or sharp pain at and around the science of degeneration. This type of arthritis is often associated with bone spur formation. The degeneration or these bone spurs may cause pressure on a nerve root or other nerve structure. If this occurs, a shooting or burning pain may be felt. In some cases, these degenerative changes can place pressure on the nerve to the point that sensation is lost or weakness occurs. In severe cases, enough pressure can be placed on a nerve or nerves to cause paralysis.

How is facet syndrome treated?

The initial treatment of facet syndrome is usually conservative. This may include rest for a few days to allow a decrease of the inflammation.  Icepack treatments over the facet joints are often helpful. Some people find heat more beneficial if the pain is not due to an acute injury.   With heat and ice, however, care must be taken to avoid burning or frostbite of the skin. Over-the-counter medications such as acetaminophen or NSAID's may be appropriate for individuals without contraindications to these medications. Physical therapy or chiropractic care is often used to decrease pain, strengthen core musculature, and improve range of motion.  Sometimes back braces can give symptomatic relief. However, caution must be used to avoid wearing the back braces too much of the time so as to avoid weakening of the core muscles.  Chiropractic care may be helpful to realign the facets and decrease restrictions in motion. For persistent pain from facet syndrome, physicians often prescribe pain medications such as tramadol or other weak opioids. Interventional pain management options such as facet joint injections or medial branch nerve blocks are often prescribed. Although commonly used, injection of corticosteroid anti-inflammatory medication into the joint space itself has shown only limited efficacy in recent research studies. Blocking the nerve to the facet joints, the medial branch nerves, helps physicians confirm the diagnosis of pain coming from the joints. For cases where the pain is persistent, destruction of these nerves with a radiofrequency neurotomy may provide more extended relief. The nerves usually do grow back over a period of time that may range from six months to two years. If they do grow back and the pain returns, the radiofrequency procedure may be repeated.

About the Author
Dr. John B. Adams is board certified in Pain Management by the American Board of Medical Specialties and the American Board of Interventional Pain Physicians. With almost 2 decades of experience, he offers patients access to state-of-the-art pain management, emphasizing a multidisciplinary approach to pain management utilizing precision injections, neuromodulation technology, physical therapy, behavioral medicine and judicious use of medications including help with patients titrating off opiates (narcotic pain medications).

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