Facet syndrome (facet joint syndrome, arthrosis of the vertebral joint)Facet syndrome (facet joint syndrome, arthrosis of the vertebral joint)

The inflammation of the facet joints (vertebral joints) is called facet syndrome. Due to wear and tear on the small vertebral joints, the facet system is a frequent cause of back pain. Please inform below about myptomas, diagnosis and therapy possibilities of facet Syndrome.

Where are the facet joints and what is their function?

The facet joints connect the vertebral arches of two adjacent vertebrae and are arranged in pairs, i.e. there is a left and a right facet joint. They are located in the back of the spine. After all, 20% of the total axial load is absorbed by the facet joints. This total load corresponds to a multiple of the body weight due to the tension of the back and abdominal muscles. The joint cartilage of the facet joints is correspondingly thick, compared to the size of the joint, it is the thickest joint cartilage in the human body.
The facet joints have a joint capsule that only loosely surrounds the bony joint partners. Thus, the relatively flaccid capsule enables the large range of motion of the spine. At the same time, the possible movement of a certain segment of the spine is also determined by the position of the facet joints. This position of the facet joints varies depending on the section of the spine. While they are inclined at the lumbar spine approx. 45 ° to the frontal axis and thus limit above all the rotation, they lie on top of each other at the thoracic and lumbar spine like roof tiles. These roof tiles are arranged more horizontally on the cervical spine and more vertically on the thoracic spine. At the cervical spine the mobility between two vertebrae is therefore very high. The mobility of the thoracic spine is also reduced by the attached bony thorax. The position of the facet joints allows rotation in particular, but a lateral inclination is hardly possible.
Since the facet joints lie anatomically behind the intervertebral discs, they are particularly stressed when the trunk tilts back (e.g. during impact in tennis or when working overhead).

What is arthrosis of the facet joints?

As with any other joint in our body, the cartilage of the facet joints wears over time and arthrosis develops. It is important to know that the joint cartilage of the facet joints does not have its own blood supply and therefore cannot receive any nutrients directly from the blood. The nutrition as well as the removal of metabolic products takes place via the adjacent tissue. Nutrients migrate along a concentration gradient into the cartilage. In the same way, metabolic degradation products leave the articular cartilage in the other direction. Movement and dosed load are therefore very important for the nutrition of the joint cartilage of the facet joints. Lack of exercise but also excessive strain hinder the nutrition of the cartilage and it comes to the destruction of cartilage cells, thus to arthrosis.

In addition to a reduced cartilage thickness, osteoarthritis leads to stabilizing bony attachments to the facet joint and to increased production of synovial fluid in order to maintain the function of the facet joints (stability and movement). The increased production of synovial fluid can lead to sacculation of the joint capsule, so-called facet joint cysts. When these cysts protrude into the spinal canal, they can press on the nerve roots there and even cause pain, numbness or paralysis in the leg.

What is facet syndrom?

Typically, however, arthrosis of the facet joints causes pain in the back, which increases when the trunk tilts back. In addition, there is a so-called "pseudoradicular" pain radiation. This means that pain in the leg occurs, which impresses like nerve pain. In reality, however, it is a transmitted pain from the facet joint that can radiate through the buttocks into the back thigh, sometimes also into the groin.

How can I diagnose facet syndrom?

In addition to the evaluation of imaging procedures such as an x-ray and/or an MRI of the lumbar spine, the physician can identify the painful facet joint by injecting a local anesthetic into the facet joints (so-called floor diagnostics). Each segment must be checked individually. If the local anaesthetic is injected simultaneously to several facet joints, it is impossible to say in retrospect which floor has actually caused the complaints.

What therapy options are available?

Once the painful facet joint has been identified, there are several therapeutic options. First, the local irritation of the facet joints will be eliminated by taking non-steroidal anti-inflammatory tablets (NSAIDs, such as ibuprofen or diclofenac). If this is not successful, local injection therapy with a small amount of cortisone is recommended. This leads to a faster and more lasting anti-inflammatory effect by locally increasing the concentration of the active ingredient.

What is facet denervation?

If no long-term relief is achieved despite multiple injections, facet denervation is an effective alternative to injection therapy. The procedure was first described by Shealy in 1974 and has been modified several times since then.
During facet denervation, the small nerve branch, which sensitively supplies the facet joint and is responsible for the transmission of pain, is damaged (medial part of the posterior spinal nerve branch). This damage is caused either by cold or heat. This leads to the destruction of the protein molecules in the nerve, i.e. the nerve is not permanently severed. Nevertheless, the pain line is interrupted for a period of up to two years. 

The procedure is usually performed on an outpatient basis and requires neither anesthesia nor a scalpel. Hollow needles are placed near the nerve under local anesthesia under X-ray control. Through these needles, a thermal or cryoprobe can be guided to the nerve and denervation can be performed. After a test phase to optimize the position of the probe, thermocoagulation generates a temperature of 80° near the nerve, resulting in the destruction of the protein molecules of the nerve. In cryodenervation, damage is caused by cold (-60°). 

After a short observation phase, the patients can return home on the same day. The procedure can be repeated in the same way after two years. If the facet pains are an expression of segmental instability, only the surgical stiffening of the unstable and pain-inducing spinal segment remains if conservative therapy fails.

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