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Rehabilitation Medicine

Facet Joint Syndrome

Facet joint syndrome, otherwise known as facet joint disease, facet degeneration, facet hypertrophy or facet syndrome, is an osteoarthritic condition that affects the zygapophysial joints in the spine.
The facet joints are the areas where the vertebrae actually join together. They are designed to impart strength, flexibility and spinal integrity, as well as offer a range of defined movement for each vertebral level.
Being that these joints are involved in vertebral movement, it is normal that they will experience wear and tear from the arthritic processes and will likely show marked effects of this aging within 3 to 4 decades of life.
Facet joint diagnoses have become a hot item in the back pain treatment sector. The degeneration is there for all to see and can easily be targeted, sometimes fairly and sometimes not, as the source of symptoms in a diversity of pain syndromes.
My biggest complaint with the way facet joint pain is handled is that diagnosis usually comes by way of exclusion and anesthetic injection. Both of these techniques are extremely imprecise, leading to a higher than average chance for misdiagnosis of the condition as the true causation of suffering.
The spinal facet joints link the vertebrae to one another and provide the flexibility for individual movement of each bone. Cartilage covers the surface of the bones in the facet joints.
The joint is covered by a capsule of ligaments and soft tissue. This capsule contains synovial fluid that is used to lubricate the joint and keep it moving smoothly and without friction.
This combination of cartilage, ligament and synovial fluid keeps a young and healthy joint moving effortlessly, without any bone on bone contact. There is also a fair amount of nerve tissue that runs into each one of these lubricating capsules.
Degeneration of the facet joints is normal and will usually be noticeable by the ages of 30 to 40 in some areas of the spine. So in essence, the terminology facet joint syndrome describes a process that we know will occur, but just to what extent in a given individual remains the variable part of the equation.

Facet Joint Syndrome Diagnosis
There is considerable medical controversy about whether this is an actual condition unto itself or just the byproduct of osteoarthritis. The spinal facet joints are in constant motion and do suffer degeneration as part of their normal lifespan. The whole human body degenerates as we age, so this is no surprise. Degeneration of the facet joints is simply a normal part of life, experienced universally as we get older. Being diagnosed as having facet degeneration should be no shock to anyone past age 40.
Degeneration of these joints occurs when the cartilage wears thin and the synovial fluid leaks out or dries up. This causes increased friction in between the individual vertebra.  Is this harmful?  Is this painful? Well, it depends on who you ask.

Pain might come from the actual bone on bone contact. This makes sense. The protective measures inside the joint are designed to prevent bone to bone contact. When contact occurs, there might be some discomfort. Is this pain abnormal? No. Some minor arthritis pain is completely normal.
However, many people have worn facet joints and suffer no pain or symptoms at all. Meanwhile, other patients have very low levels of facet arthritis, but experience widespread regional back pain which is illogically traced back to the obviously coincidental facet issues. This is a huge problem.
Pain might also occur if a bone spur creates a pinched nerve. This occurs mainly due to serious spinal osteoarthritis and the build up of osteophytes around the foraminal openings. The facet joints are one of the main true sources of mechanical back pain symptoms. In these cases, the diagnosis is correct in many patients, as long as the symptoms are logical for the suspected cause, including pain over a particular and defined range of motion at a particular vertebral level.
Recommendation for Facet Joint Syndrome
Facet joint syndrome is a normal part of aging. If you think of it this way, you are unlikely to suffer serious symptoms. Some aches and pains are normal as we get older. They are unavoidable. However, serious facet joint pain is rare.
Facet syndrome is also one of many structural conditions that have become popular scapegoats for treatment-resistant back pain. If this is your situation, learning more about knowledge therapy might be the approach to care you really need. No risks and no costs. Compare that to the multitude of drugs and injection therapies used unnecessarily each year to treat completely innocent and coincidental facet degeneration.

[Update: 2020 - 03 - 09 ]