Orthopaedic Conditions

CONDITIONS OF THE SPINE

• Facet Joint Syndrome

The facet joints are paired, true synovial joints endowed with cartilage, capsule, meniscoid, and synovial membrane. They are small joints that sit on top of one another like shingles on each side of the spinal canal helping to form the bony "roof" over the spinal nerves. There are 2 facet joints for every motion segment of the spine (one on each side). They are connected by a capsule of tissue and contain joint fluid. The capsule serves to limit bending forces and to resist a backwards sliding motion during extension. Each joint is innervated by nerves that serve a function of pain sensation and regulation of blood flow to the joint. When the spinal discs are damaged from trauma or the aging process, arthritic changes may result in excessive motion between the vertebral bones above and below the damaged discs. With time, this excessive motion can transfer more strain to the facet joints on the back of the spine resulting in grinding of the bone ends together, thickening of the joint capsule, and bony overgrowth. This can lead to pain with extension of the spine or lying flat. It can also lead to crowding of the spinal canal as the disc bulges back and the facet joints bulge forward, compressing the nerves of the spine (spinal stenosis). There are many effective treatments for the condition including physical therapy that focuses on stretching/forward flexion of the spine, medications, and injections into the joints or the nerves that supply the joints with the sensation of pain. If these injections are effective, but short-lived, some practitioners use radiofrequency to deaden the sensitive nerves that result in the sensation of pain from abnormal facet joints.