What is Facet Syndrome?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Facet syndrome is defined as the pain that is caused when the facet joints become torn, worn out, and swollen. Because of the constant movement and repetitive stress being forced onto the joints, the facet joints can become inflamed and cause the individual pain and stiffness. The pain associated with facet syndrome has the reputation of getting worse among most patients when the joints have not experienced movement for long periods of time, and previous individuals that have been diagnosed with facet syndrome also claim that the pain from the syndrome is also elevated in the morning as well as at night before bed. 

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More About Facet Syndrome

lumbar foraminotomy

The human spine is formed from bones called vertebra stacked on top of each other. Located on the front side of each of these vertebrae is a large disk that is responsible for adding support and as well flexibility to the spine and the individual’s body. Not only this, but also located on the sides of each of the vertebra are joints classified as facet joints. Facet joints are defined as joints that support and stabilize your body, giving your back the ability to bend and twist. These facet joints are surrounded by cartilage, which also allows your vertebrae to move without harming the other vertebrae around it.

Overall, facet joints are responsible for giving your body the stability it needs to support your weight, and they’re the reason why we are able to stand up with a straightened posture. All of these features are what facet joints are intended to have, but this is not always the case. Sometimes after facet joints have undergone repetitive and constant motion, the cartilage around the joints can become swollen. This swelling can disrupt the joint’s purpose and harm material near it.

The pain associated with facet joint syndrome differs by individual. It also differs according to the location of the joint or joints affected. Facet joints located in the cervical region will affect the shoulders, the upper-back, or the neck. On the other hand, facet joints located in the thoracic region of the spine will hit the midline, or mid-back. And lastly, the facet joints that are located in the lumbar region of the spine are known for their ability to cause pain to the hips, buttocks, or groin. 

What are the symptoms?

  • Back Pain: Most patients that have been diagnosed with facet syndrome claim that they cannot locate the pain because it is generalized.
  • Numbness or Muscle Weakness: Facet joints are attached to vertebrae, which are surrounding and protecting the spinal cord; therefore, our facet joints affect our body’s nerves.

The location of the nerves in our body typically depends on which facet joints are damaged. For instance, if the damaged facet joint is affecting nerves located in the cervical region of our body, then we may experience pain, numbness, or muscle weakness in our neck, shoulders, or arms. On the other hand, if the damaged facet joint is affecting nerves located in the lumbar region of our body, then we may experience symptoms in our legs, feet, and bottom. Some additional symptoms associated with facet syndrome may include tenderness over joints and discomfort leaning forward and backward

How is Facet Syndrome Diagnosed?

Pain is the first indicator of a bulging disc that needs attention. Once identified, there are typically four steps to the process

•  Medical History:

Facet syndrome can first be diagnosed with a visit to the doctor’s office, in which the doctor will start with obtaining information about your medical history, and they will also usually give you a physical examination.

•  Diagnostic Imaging:

Doctor will order an X-Ray scan. If they find any abnormalities, they will order a CT scan. The CT scan shows the facet joints plus the other segments of the spine, and it shows more detail about the surfaces of the facet joints. In addition to this, the doctor may possibly order an MRI scan, but it’s not likely that this will show any problems with the facet joints particularly.

•  Spinal Injection:

In this procedure, the doctor will inject a local anesthetic into the facet joint using a needle and a fluoroscope. When the needle is placed in the correct location, the anesthetic is injected and the doctor can diagnose the patient with facet syndrome if the patient’s pain is relieved after the anesthetic was injected into the facet joint. 

Interestingly enough, there are many cases where disc problems don’t actually cause pain; an MRI, in itself, is not enough to serve as diagnosis. It’s only when the physical exam and symptoms match up with the imaging results that a diagnosis can truly be established.

What are the Causes of Facet Syndrome?

low back pain

  • Trauma/ Injury: One of the most common situations that cause an individual to obtain facet syndrome because the spine is an easy, vulnerable area of our body to damage.
  • Aging: Aging is the natural process that may cause facet syndrome and it’s the most popular.
  • Abnormal Postures: Bad Posture in youth causes facet syndrome because the spine is forced to do extra work in supporting the individual, causing the facet joints to wear down quickly.
  • Spondylolisthesis: Causes facet syndrome because this disease takes place when one vertebra slips over another vertebrae. When this happens, the fluid or cartilage surrounding the facet joints responsible for lubrication are worn down or damaged, causing bone to come into contact with bone.

How is Facet Syndrome Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Facet Syndrome

A fluoroscope is used as x-ray assistance in viewing where to inject the needle containing the anesthetic. A needle is also used to inject the anesthetic. Additional equipment used in treating and diagnosing individuals with facet syndrome are radiofrequency needles, x-rays, and CT scans. Each of these pieces of equipment can be used in both the treatment as well as the diagnosis of facet syndrome. 

More specifically, the needle used to inject the anesthetic measures anywhere from 3.5 to 5 inches long. The flousoscope is an X-ray tube that is attached to a TV-monitor that duplicates the image that the x-ray picks up. Sometimes also used instead of the fluoroscope to ensure that the needle is injecting into the correct location is a CT scan. The CT scan is often described as a large machine shaped like a box with a tunnel in the center of it. 

How Does Facet Syndrome Compare to Similar Spine Conditions?

Arthritis is the inflammation of one or more joints, and this condition has similar symptoms to facet syndrome because individuals that have arthritis also have joint pain and joint tenderness. Not only this, but a condition known as osteoarthritis is similar to facet syndrome because it’s a type of arthritis in which the flexible tissue around the ends of bones wears down, causing pain. Osteoarthritis similar to facet syndrome because it causes joint tenderness, joint pain, as well as joint stiffness. 

A herniated disc is also similar to facet syndrome. A herniated disc is defined as a deep infection, fracture, or torn muscle of the spine or the lower back that causes joint inflammation. Additionally, SI joint pain is also similar to facet syndrome. the SI joint is abbreviated as the sacroiliac joint, in which our body contains 2 of and is located in the lower back-region of our bodies. SI joint pain is similar to facet syndrome because both the SI joint as well as facet joints are responsible for supporting and stabilizing our bodies’ postures. Not only this, but in both spine conditions, there is pain from joint inflammation as well as pain in the lower/upper back, thighs, or groin. 

Analogy: A Bicycle Chain

Your facet joints are like the chains on a bicycle: they help give you motion. If they become swollen from age, misuse, or an injury, they will not be able to function properly. The bike will not move well, and you will feel pain. The same is true when you develop facet syndrome in your spine.

Good Bicycle Chain

Bad Bicycle Chain

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