Facet Joint Syndrome – Pain Management

The spine is composed of individual bones called vertebrae, and a healthy spine has three primary curves in the cervical (neck), thoracic (upper back), and lumbar (lower back) regions.

Each vertebra, except the first two, connects to its neighbor through a pair of facet joints. These joints help stabilize the spine while allowing flexibility. The bone surfaces within the facet joints are covered in cartilage, providing a smooth surface that facilitates movement. These joints are lined by a synovial membrane that secretes synovial fluid, which lubricates and cushions the bones, reducing friction and preventing joint damage.

Facet joint syndrome often results from the natural aging process, where joint cartilage wears down over time, causing painful bone-on-bone contact. Conditions like arthritis, injury, infection, degeneration, and nerve compression also contribute to the development of facet joint syndrome.

Facet joint syndrome can affect any section of the spine but is commonly seen in the neck (cervical spine) and lower back (lumbar spine). In the cervical spine, it may lead to neck, shoulder pain, stiffness, and headaches, often making it difficult to turn the head. In severe cases, you might need to turn your entire body to look sideways, potentially resulting in a hunched posture.

Facet joint syndrome in the lumbar spine can cause pain in the lower back, buttocks, and back of the thighs. Pain and stiffness may also make it challenging to stand up or move, such as rising from a chair.

A doctor diagnoses facet joint syndrome by reviewing your medical history, examining your spine, and conducting imaging tests like X-rays, CT scans, or MRIs to identify structural changes. A facet joint injection may also be performed to pinpoint the pain's source.

Most people manage facet joint syndrome through medication, physical therapy, and lifestyle adjustments. Non-steroidal anti-inflammatory medications can reduce pain and inflammation, and muscle relaxants may also be prescribed.

Physical therapy can provide relief by teaching correct postures for daily activities and introducing exercises to improve strength and flexibility. If these methods don’t alleviate symptoms, a radiofrequency neurotomy can offer longer-term relief. In this procedure, heat is applied to the nerve to disrupt pain signals, essentially "deactivating" it.

It can take around three to four weeks for the treated nerves to die completely. During this time, some people may experience mild pain and weakness in the affected area. Radiofrequency neurotomy typically provides relief for up to a year, allowing for a return to favorite activities, and the treatment can be repeated if symptoms return.