facet syndrome

Facet syndrome: description

The facet joint syndrome is characterized by pain originating in the small vertebral joints. Behind this is an overload, which is often triggered by a reduced distance between the vertebral bodies, such as by aging and wear of the intervertebral discs.

Already in 1911 doctors have discovered the facet joints as a possible cause of back pain. Some experts suspect that the facet joint is involved in about 80 percent of the vertebral pain at least. Often the lumbar area is affected (lumbar facet syndrome).

What are facet joints?

In the case of disc damage, the height of the intervertebral disc usually also decreases, as a result of which the vertebral bodies lie closer to one another. The facet joints are among the connections between the vertebrae. If the distance, ie the height, between the vertebrae is reduced, the facet joint also no longer functions correctly and is misloaded, from which a facet syndrome can result. The facet joint is well supplied with nerves and pain fibers, which explains the pain of joint damage.

The spine consists of 33 vertebrae. The vertebrae each consist of a vertebral body, followed by the vertebral arch at the back. The vertebral arch encloses the spinal cord. Between the vertebral bodies, the discs sit like little pillows. They provide the space between the vertebrae, catching bumps and, above all, allowing movements of the vertebrae against each other.

The vertebral arches have extensions up and down. Two lower processes form the so-called facet joint with the upper processes of the underlying vertebral arch. It is covered by a thin layer of cartilage and crossed by pain-sensitive nerves. If the pressure on the articular surfaces increases as a result of wear and tear, severe pain may arise, to which the body reacts with an involuntary hardening of the surrounding musculature. This is to reduce the particularly pain-inducing movements.

Facet syndrome: symptoms

The main symptom of facet syndrome is pain. This pain is usually dull, not exactly localizable and one or both sides. But it can also be piercing or boring. During the day, the pain often increases, as the spine is burdened by the upright walk during the day, while it is largely relieved at night. At the same time, the spine can feel stiff in the morning or after a long period of rest.

In addition, in the context of facet syndrome, hip pain or leg cramps can occur. The pain can radiate into the legs and be additionally strengthened by stretching the spine. But even with strain on the spine, the pain increases. Overall, the symptoms of a facet syndrome can lead to severe restrictions on the activities of daily living.

Facet syndrome: causes and risk factors

The causes of the facet syndrome are discussed controversially among experts. Very often, degenerative, ie wear-related, damages of the vertebral joints are considered the cause. But also damage to the intervertebral discs can lead to vertebral joint arthrosis. The intervertebral disc and facet joints are in a close correlation due to their similar function. Damage to one of the two structures usually leads to damage to the other. In addition to arthritis, arthritis, ie arthritis, can also trigger a facet syndrome.

Another possible cause is cysts or ganglia near the facet joint. A ganglion is a connective tissue proliferation. It usually develops in areas of high stress, in particular in the lumbar region (lumbar facet syndrome). Women are a little more affected. It is a particularly painful form of the disease.

Spinal canal stenosis (narrowing of the canal through which the spinal cord runs) can lead to painful entrapment of nerves, but also to direct joint damage. Other causes of facet syndrome include vertebral blockage, instability of the joint or reflex muscle tension. These are very hard and long lasting. They often result from overloading or instability of the spine.

Tumors or malformations of the spine, which have existed since birth, are also less common cause of a facet syndrome.

It is important, however, a so-called transmitted pain excluded. This phenomenon describes the sensation of pain in a place that is not in the vicinity of the actually damaged area. Because certain nerves feed multiple areas and internal organs, signals from another location, which travel the same way as the pain fibers of the facet joint, may be misaligned, resulting in an apparent facet syndrome. For example, diseases of the pancreas or large intestine can cause apparent back pain.

Facet syndrome: examinations and diagnosis

In almost all cases, sufferers turn to their family doctor or orthopedist due to back pain. It is important to study the pain symptoms carefully. For this purpose, the characteristics of the pain must be precisely queried:

• Where is the pain strongest?
• Is it a persistent pain?
• Did you have previous pain episodes?
• Which treatments have already been tried?
• How much does pain affect everyday life?
• Are there any specific triggers?
• Do you have other comorbidities?
• Are you currently mentally stressed?

In addition, standardized pain questionnaires are often used.

In the physical examination It is noticeable that there is pressure pain in the pain area. The muscles on the side of the spine are often tense. If the spine is stretched backwards, the pain will increase in addition. At the same time, however, there are generally no neurological abnormalities, ie, reflex disorders, emotional and sensory disorders or paralysis. The presence of such symptoms would be a warning sign of other spinal disorders such as a herniated disc or severe spondylolisthesis (spondylolisthesis).

It is useful to have damage or overload of the facet joint imaging demonstrated. In general, one will X-ray photograph made from two different directions (planes). Also Computed tomography (CT) and MRI (MRI) are useful for visualizing changes in the vertebral joints.

A safe way to detect a facet syndrome is by trial injection of local anesthetic into the joint area (diagnostic facet blockage). This stuns the nerve (ramus dorsalis of the spinal nerve). The pain signals are transported via this nerve. The injection should be under the control of an imaging technique such as CT or MRI.

Before considering a facet syndrome treatment, one can check its chances of success with a so-called pain provocation. For this purpose, a large amount of high-percentage saline solution is injected into the joint. When pain is triggered or aggravated, the chances of recovery from invasive surgery are good.

Note: Under certain conditions, recognition as an occupational disease should be considered. However, such recognition is usually very difficult with the facet syndrome.

Facet syndrome: treatment

How a facet syndrome is treated on a case-by-case basis depends on several factors. Among other things, the exact cause and severity of the complaints play a role.

First, one usually tries to use the facet syndrome conservative (non-operative) methods to treat. So experts assume that a relief of pain not with exclusive protection, but by switching with passive movement (physiotherapy) can be achieved. Other methods are, for example occupational Therapy, Manual therapy, massages and also the back exercises, with the sufferers train their back and learn back-friendly movement techniques. This support is a crucial pillar of pain control and an unstable spine through the facet syndrome. Exercises aim to strengthen the muscles on the one hand, but also to stretch and improve their coordination on the other hand. The patients learn to deal with the pain and to fight it.

The treatment can be through pain medications get supported. Often, so-called non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or paracetamol are used. For severe pain, you may want to use stronger medications, including opioids. Sometimes muscle-relaxing drugs (muscle relaxants) are useful.

Another treatment option is to inject a local anesthetic with or without cortisone into the vicinity of the facet joint or directly into the joint. These facet infiltration must be placed precisely. Therefore, the position of the injection needle is controlled by means of imaging.

A longer-term relief of pain can be achieved by a Facet denervation achieve. The function of a nerve branch in the area of ​​the facet joint is impaired. This is possible either by means of, for example Radio frequency therapy (or thermocoagulation). The pain-sensitive nerve is “obliterated” (coagulated). This can relieve the pain for months or sometimes even more than a year. A Facettendenervierung but can also with Cooling probes (cryoprobes) or one laser treatment to reach.

Note: Some patients with facet syndrome also use alternative methods such as acupuncture.

If the symptoms of a facet syndrome persist despite conservative therapies, one may surgery to be considered. There are various possible methods, such as the removal of nerves or the stiffening of a spinal column section. The treating physician will decide on a case-by-case basis which technique is most suitable.

Facet syndrome: disease course and prognosis

The prognosis of the facet syndrome and the chance of freedom from pain depends above all on the spinal column changes that underlie the syndrome. Often a consistent therapy can achieve a lasting relief of the pain. This and enabling a good quality of life are the main goals of facet syndrome therapy.

Above all, the structure of the stabilizing musculature is important. The physiotherapy must provide a guide to self-help. The facet syndrome It is often associated with other spinal injuries and should always be considered and specifically treated as a possible cause of severe back pain.