Facet joints are located in pairs at the rear of each vertebra and help to link adjoining vertebrae. Also known as zygapophysial joints or Z-joints, facet joints are comprised of cartilage and a joint capsule that is surrounded by synovial fluid, thereby allowing the joint to glide freely. Facet joints work together to allow free movement of the spine, yet are motion-restricting in that they limit the range of motion to protect the discs. One of the most common causes of lower back pain and neck pain in adults is a disorder of the facet joints.
In the neck region, facet joint disorders might cause headaches, neck pain when the head is turned, or shoulder pain. Facet joint disease in the lower back may present as low back pain, pain when arching or twisting the back, a dull ache in the buttocks or the backs of the upper thighs, or pain when rising from a seated position. Pain in the facet joints may arise from sports injuries, wear and tear of the vertebrae, deterioration of the cartilage covering the joints, or inflammation of spinal nerves. Disorders are more common with age because of years of joint wear, cartilage thinning, and bone degeneration.
An x-ray, computerized axial tomography (CT) scan, or magnetic resonance imaging (MRI) procedure could help identify signs of degeneration and rule out other problems. A facet joint block may be used to definitively diagnose facet joint syndrome. In this procedure, nerves near the facet joint are injected with anesthetic. If the pain subsides when the nerves are numb, the diagnosis is quite likely to be facet joint syndrome. Nerve blocks may also be used to temporarily relieve pain when activity changes fail to provide relief.
Treatment of facet joint syndrome usually begins with non-surgical options, such as changes in activity, exercise, physical therapy, posture correction, and learning correct lifting techniques. Anti-inflammatory medications and heat application may be used to temporarily relieve pain. Frequently, lifestyle changes alone are enough to bring relief for many patients.
If non-surgical options don’t relieve the pain, a procedure called a facet rhizotomy may be used to permanently destroy nerve endings that are causing the pain. A hot probe is guided into the nerve to deliver an electrical current to the nerve ending. Most patients who undergo this procedure obtain moderate to complete relief from back pain. If a rhizotomy does not work, spinal fusion surgery may be needed.