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Facet Syndrome: Causes, Symptoms and Treatment

Facet syndrome is a common spinal pain condition caused by degenerative changes or irritation of the small facet joints connecting the vertebrae of the spine.

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Things worth knowing about "Facet syndrome"

Facet syndrome is a common spinal pain condition caused by degenerative changes or irritation of the small facet joints connecting the vertebrae of the spine.

What is Facet Syndrome?

Facet syndrome (also called facet joint syndrome or zygapophysial joint syndrome) refers to pain and functional limitations originating from the facet joints of the spine. These small joints, located at the back of each vertebra, connect adjacent vertebral bodies and allow for the flexibility and movement of the spine. When these joints become inflamed, irritated, or worn down due to degeneration, they can cause significant pain and discomfort.

Facet syndrome can occur in any region of the spine, but it most commonly affects the lumbar spine (lower back) and the cervical spine (neck).

Causes

Facet syndrome can develop due to several underlying causes:

Degenerative changes: Cartilage wear and tear (osteoarthritis or spondylarthrosis) is the most common cause, particularly in older adults.
Overuse and poor posture: Prolonged desk work, heavy lifting, or sedentary lifestyles can place undue stress on the facet joints.
Trauma: Injuries such as whiplash or vertebral fractures can damage the facet joints directly.
Disc degeneration: As intervertebral discs lose height, the load distribution shifts to the facet joints, accelerating their wear.
Inflammatory conditions: Rheumatic diseases such as ankylosing spondylitis can also affect the facet joints.
Excess body weight: Increased weight places additional strain on the spinal joints.

Symptoms

The typical symptoms of facet syndrome include:

Localized back or neck pain that worsens with backward bending (extension) and rotation of the spine.
Morning stiffness and pain when starting to move after rest.
Referred pain into the buttocks, thighs, or shoulders – typically dull and diffuse, without a clear dermatomal pattern.
Worsening pain when standing or walking, with relief when sitting or bending slightly forward.
In the cervical region, additional symptoms such as headaches, neck stiffness, and dizziness may occur.

Diagnosis

Diagnosing facet syndrome involves a combination of approaches:

Medical history and physical examination: The physician assesses the nature of the pain and tests spinal range of motion and specific pain provocation maneuvers.
Imaging: X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) can reveal degenerative changes in the facet joints.
Diagnostic facet joint injection: A targeted injection of local anesthetic into the suspected joint confirms the diagnosis if it provides significant pain relief.

Treatment

Treatment of facet syndrome depends on the severity and underlying cause of the condition. A multimodal approach is usually recommended:

Conservative Treatment

Physical therapy: Exercises to strengthen the back and core muscles and to improve posture are the cornerstone of conservative management.
Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac help reduce pain and inflammation.
Heat and cold therapy: Local heat applications can relax muscles and ease pain.
Manual therapy and osteopathy: Manual techniques can help restore joint mobility and reduce pain.

Interventional Treatment

Facet joint injection: Injection of corticosteroids and local anesthetic directly into the affected joint provides targeted pain relief.
Radiofrequency ablation (denervation): The small nerve branches transmitting pain signals from the facet joint are deactivated using heat, providing longer-lasting relief.

Surgical Treatment

Surgery is rarely required for facet syndrome and is only considered in cases of persistent, treatment-resistant pain with significant impairment of quality of life.

Prevention

Preventive measures include regular physical activity, ergonomic body mechanics in daily life, maintaining a healthy body weight, and strengthening the back and core muscles through targeted exercise.

References

Bogduk, N.: Clinical and Radiological Anatomy of the Lumbar Spine. 5th edition, Elsevier Churchill Livingstone, 2012.
Cohen, S.P. & Raja, S.N.: Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology, 106(3):591–614, 2007.
National Institute for Health and Care Excellence (NICE): Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59, 2016. Available at: www.nice.org.uk

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