Facet Syndrome

Anatomy

Each vertebra, there are 33 that make up the vertebral column, has four facet joints. Facets are the smooth, flat surfaces of the vertebrae that interlock and allow the spine to flex. Facet joints permit gliding movements between the vertebrae. These joints are in constant motion, providing the spine with the stability and flexibility needed to walk, run, bend, sit and twist.

Two of the joints connect the vertebra above; they are called superior facets. The pair that connects the vertebra below are called inferior facets.

Just like other joints within the body, each facet joint is surrounded by connective tissue and produces fluid to lubricate the joint. The surfaces of the joint are coated with cartilage, which helps each joint move smoothly.

What Is Facet Syndrome?

As we age, the cartilage that lines the facet joint surfaces gradually wears away due to constant, repetitive motions. In many cases, growths called bone spurs can develop. The bone spurs often grow along the edges of the bones and are most commonly found in joints.

Friction between the bones can cause tenderness, swelling, stiffness and facet joint pain. When seen in adults over the age of 50, facet syndrome can result in arthritis. Though generally the result of the natural aging process, facet joint syndrome may also be caused by an injury or overuse of certain joints while on the job or playing sports.

While facet syndrome can occur at any level of the spine, it is most common in the lower back or lumbar region.

There are a number of terms used to describe facet joint problems, including:

Facet joint syndrome
Degenerative facet joints
Facet arthritis
Facet disease
Facet hypertrophy
Osteoarthritis

Types of Facet Syndrome

There are a number of terms used to describe facet joint problems or facet disease. In general, all of these terms mean the same thing; arthritis or degeneration of the facet joints, including:

Degenerative Facet Joints

Refers to the condition caused by degeneration and deterioration of the small joints of the spine due to the aging process. Degenerative facet joints mostly happen in the lower back, resulting in radiating pain in that area. Degeneration of facet joints may result in facet disease or facet arthritis.

Facet Arthritis

Refers to the condition caused by arthritic changes and inflammation that can develop in spine joints. Arthritis of the facet joints usually results in “referred pain” – i.e. the pain is perceived at a location other than the actual site of the problem.

Facet Hypertrophy

Refers to the condition caused by enlargement of one or more facet joints. One way that the human body responds to the aging process and degeneration of the spine is the enlargement of the facet joints to counteract the lost stability caused by degeneration. This enlargement can put pressure on the nearby nerves and therefore cause radiating pain. Facet hypertrophy mainly occurs in the lumbar region of the spine.

Causes of Facet Syndrome

Facet syndrome causes are generally the result of the natural aging process. However, the initial cause of facet syndrome may also be an injury, such as whiplash, or overuse of the joints.

Another possible cause of facet disease is spondylolisthesis, which is when one vertebra — usually in the lumbar spine — slips forward over the lower vertebrae. When the facet joints become inflamed due to injury or age, the result is stiffness and pain. As the facet joints deteriorate, they may also lose proper alignment, which can cause pain. Additionally, rubbing on the joints wears out the cartilage and fluid that lubricates them. As a result, bone can rub on bone, which results in painful back problems.

Common Causes of Facet Pain

Aging
Injury
Misuse
Wear and Tear

The Bonati Spine Institute encourages patients with facet syndrome to contact us to request a no-obligation MRI review or discuss your conditions with our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the world’s best solutions when it comes to advanced spine surgery. Your pain from facet disease can become a thing of the past.

Facets are compressed when an individual leans backward or to the side, so someone with a facet problem may feel pain in those positions. Leaning forward reduces the stress on the facet joints.

Facet syndrome symptoms related to facet joint problems are usually localized near the area of the facet joint. Therefore, symptoms differ depending on the location:

Lumbar Facet Joint Pain

Lower back pain that may radiate into the buttocks and upper thigh area
May be misdiagnosed as sciatica

Thoracic Facet Joint Pain

Facet syndrome is in the thoracic region of the spine, which may result in pain in the central region of the spine, between the lower back and the shoulders
One study suggests that referred pain from thoracic joint pain may appear as abdominal pain

Cervical Facet Joint Pain

If the cervical vertebrae is affected, pain can occur in the back of the neck and radiate to the top of the shoulders and then radiate to the anterior neck
Headaches at the base of the skull

Some other symptoms those suffering from facet syndrome may experience include:

Pain that worsens in the beginning and end of the day or with changes in the weather
Abnormal curvature of the spine
Difficulty standing or sitting for long periods of time

Most patients will experience acute episodes of facet joint pain. Because the episodes ca be recurrent and unpredictable, some patients may believe it is all psychosomatic and the pain is being aggravated by stress.

When Does Facet Joint Pain Become Chronic?

When the facet joint pain lasts for three months or longer, it may be considered chronic and also may be referred to as facet joint syndrome. The facet joint pain may occur on its own or in combination with other conditions that cause low back pain.

Diagnosing Facet Syndrome

As with most spinal conditions, diagnosing facet syndrome begins with a thorough clinical evaluation, including a complete medical history, analysis of your symptoms and physical examination. Testing may include x-rays, MRI scan, or CT scan.

Pain related to facet syndrome can also be diagnosed through a diagnostic facet injection, a numbing medication, injected into the facet joint. To determine which facet joint(s) is the cause of the pain, medication is injected into the involved facet joints. The alleviation of pain supports the diagnosis that one or more facet joint(s) are the pain generator(s).

Treatment for Facet Syndrome

The facet joints are the joints that connect each of their vertebrae to each other in order to allow for motion of the spine. Pain related to the facet joints is often called facet syndrome and it can be easily diagnosed. This is accomplished by doing a diagnostic facet injection, a numbing medication, injected into the facet joint. To determine which facet joint(s) is the cause of the pain, medication is injected into the involved facet joints. The alleviation of pain supports the diagnosis that one or more facet joint(s) are the pain generator(s).

Through advanced minimally invasive spinal surgery, the surgeons perform the Bonati facet debridement by using arthroscopes and lasers to vaporize irritated and painful nerves around the facets of the vertebrae.

The Bonati Spine Procedures uses specially designed probes and the Holmium YAG Laser to remove pain-inducing tissue in nerve branches above and below the affected facet joints on the spine. After a small incision is made, a tiny fiber optic camera is used to visualize the exact facet problem area and a laser is used to vaporize the painful nerves around the affected area.

The Bonati Spine Institute is the world leader in advanced spine surgery with the first spinal ambulatory surgical center in the United States. The Bonati Spine Institute is also the first spine institute in the United States to receive FDA approval for laser spine surgery and patents for instrumentation for spinal surgical procedures. With more than 75,000 successful procedures performed with proprietary procedures and instrumentation, we are proud to have over 98.75% patient satisfaction for long term relief and facet syndrome treatment options. The Bonati Spine Procedures usually take less than 1-hour and most patients find immediate relief.

The type of pain you experience with facet syndrome is similar to many other spinal conditions. Accurately diagnosing the source of the pain is critical in obtaining facet syndrome treatment that will be successful.

Non-Surgical Treatment

Conservative treatments can be used to treat face joint pain. Some of the treatment options include:

Soft tissue massage
Spinal manipulation
Back braces for correcting posture
Anti-inflammatory non-steroidal drugs
Muscle relaxers
Physical therapy

Steroid injections can help relieve pain for a long period of time as well.

Surgical Treatment

The Bonati Spine Institute is the world leader in advanced spine surgery, and is also the first spine institute in the United States to receive FDA approval for the use of the Holmium YAG Laser in spine surgery. More than 75,000 successful procedures have been performed with proprietary procedures and instrumentation.

The Bonati Spine Procedures use specially designed probes and the Holmium YAG Laser to remove pain-inducing tissue in nerve branches above and below the affected facet joints on the spine. After a small incision is made, a tiny fiber optic camera is used to visualize and treat the exact facet problem area.

Prevention & Self-Care

As facet joint pain is linked to aging, it may not be entirely preventable. Still, adults can make some lifestyle changes in order to keep their back and spine healthy and prevent facet pain from becoming debilitating.

Some steps you can take to prevent facet joint pain include:

Staying active and fit
Eating a healthy diet
Reducing stress
Avoiding tobacco use
Limiting alcohol consumption
Improving your posture

The Bonati Spine Surgery For Facet Joint Syndrome

The Bonati Spine Procedures offer an array of surgical techniques for the treatment of facet syndrome. These procedures may include:

Facet Thermal Ablation for Facet Syndrome

Facet Thermal Ablation (Rhizolysis) is the use of heat to deaden sensory nerves that are irritating the facet joints, causing pain. Facet joints are the joints in your spine that make your back flexible, and enable you to bend and twist. Nerves exit the spinal cord through these joints. Healthy facet joints have cartilage that allows your vertebrae to move smoothly against each other without grinding. Facet disease occurs when the cartilage in the joints deteriorates, as a result of wear and tear, aging, injury or misuse. This may cause the joints to become misaligned, causing pain. Also, when facet joints become inflamed, stiffness and/or pain can occur.

Facet Thermal Ablation (Rhizolysis), may be performed by our surgeons as part of the Bonati Spine Procedures, however the spine surgeons at the Bonati Spine Institute are able to relieve the pain by decompressing the affected nerves and therefore rarely performing an ablation.

The Facet Thermal Ablation (Rhizolysis) is performed during a Bonati Spine Procedures utilizing local anesthesia and conscious IV sedation, allowing the patient to be comfortable, responsive, and able to provide feedback to the doctors throughout the procedure. This allows our surgeons to target the source of pain with pinpoint accuracy.

While in the operating room, the surgical team will confirm the patient is able to complete a series of mobility exercises and verify that the pain has been successfully treated. After the procedure, the patient is transferred to the post-operative care unit for rest and observation, and then a post-operative consultation with the surgeon will help determine if additional procedures included in the surgical plan are necessary. Follow-up surgeries are usually scheduled within a few days of the first surgery, to allow any swelling to subside. During this time, the patient will be given a regimen of walking therapy.

Laser Posterior Decompression for Facet Syndrome

Removes bone spurs or enlarged ligaments that are compressing the spinal cord and the nerves leading to the arms.

Facetectomy

A facetectomy, also called a partial inferior facetectomy, is performed to relieve pressure on spinal nerve roots. Facets are the smooth, flat surfaces of the vertebrae that interlock and allow the spine to flex. Facet joints permit gliding movements between the vertebrae. These joints are in constant motion, providing the spine with the stability and flexibility needed to walk, run, bend, sit and twist. As we age, the cartilage that lines the facet joint surfaces, allowing them to glide easily over one another, gradually wears away, and in many cases growths called bone spurs can develop.

Facet Surgery Friction between the bones can cause tenderness, swelling, stiffness and arthritis. This friction also may cause inflammation of the posterior (dorsal) rami (branches or divisions) of the spinal nerves. When these nerves become irritated, they send pain signals in their localized area.

A facetectomy may be utilized to vaporize the dorsal rami nerve fibers that have become inflamed. During this procedure, a small incision is made through which a series of tubes patented by The Bonati Spine Institute are inserted. These tubes accommodate an endoscope and surgical tools, which may include the Holmium laser, which is used to vaporize the nerve fibers. A small portion of the facet bone that is on the nerve may be removed, allowing access to the affected nerve(s). The laser may then be employed to stop the affected nerve from transmitting pain signals from the injured facet joint to the brain.

A facetectomy may be a part of an array of procedures performed by The Bonati Spine Institute. Laminotomy/laminectomy is often performed along with facetectomy to remove a portion of the ligamentum flavum, a ligament in the spinal canal that eventually thickens and compresses the spinal cord, resulting in spinal stenosis. When a portion or a segment of the ligament is removed through laminectomy/laminotomy, the spinal canal is opened, relieving pressure on the nerves. Some patients experience immediate relief during the Bonati Laminotomy as the nerve(s) are released. Because we have decompressed the spinal canal, the patient’s symptoms of neck/back and arm/leg pain are relieved. After the surgery, the patient is encouraged to walk with a companion and is monitored until discharge, returning the next day for a post-operative evaluation.

The Bonati Spine Institute does not use general anesthesia. Through the use of conscious IV sedation and local anesthesia the patient is comfortable, responsive, and able to provide feedback to the doctors throughout the procedure. This allows our surgeons to target the source of pain with pinpoint accuracy. While in the operating room, the surgical team will confirm the patient is able to complete a series of mobility exercises and verify that the pain has been successfully treated. After the procedure, the patient is transferred to the post-operative care unit for rest and observation, and then a post-operative consultation with the surgeon will help determine if additional procedures included in the surgical plan are necessary. Follow-up surgeries are usually scheduled within a few days of the first surgery, to allow any swelling to subside. During this time, the patient will be given a regiment of walking therapy.

Contact The Bonati Spine Institute today and speak with a Patient Advocate to answer your questions.