Facet joint syndrome

Facet joint syndrome is a disease associated with degeneration and damage to facet (intervertebral) joints, manifested by local pain. Excessive in amplitude, often repeated rotation, flexion and extension of the spine can lead to degenerative changes in the intervertebral joints. Reduced height of the intervertebral discs results in increased vertical load on the facet joints, which accelerates degenerative changes in the joints. More than 50 percent of people at the age of 20-29 years have anatomical changes in the facet joints, as well as 93% of those aged 40-49 years, and 100% of people after 60 years of age. Facet joints are most often and most severely affected at the level of the 4th - 5th lumbar vertebrae and in the cervical spine. Facet joint syndrome most often develops in older people, because joints’ lesions progress with age. Degenerative changes in facet joints can occur in completely healthy people, having no complaints of back pain. There is no direct association between the radiologically diagnosed arthrosis of the facet joints and the presence and severity of pain.

Clinical manifestations

Cervical facet joint syndrome includes the following symptoms:
- Pain in the neck (rarely radiating to the arm down to the elbow), usually on one side
- Pain and limited movements in the neck, especially when turning and extending the head
- Painful palpation of the affected joint
- Pain radiates to the scapular region, less often to the anterior surface of the chest and to the hands.

Lumbar facet joint syndrome may be defined by the following symptoms:
- Pain in the lower back
- Painful local palpation
- Pain, stiffness or difficulties starting the movements (e.g., it is difficult to quickly get out of the chair and start walking).
- Pain can radiate to the groin, buttock, thigh and, on rare occasions, down to the foot.

There are no specific clinical tests to confirm or exclude the diagnosis of facet joint syndrome.

To make a diagnosis of facet joint syndrome, a diagnostic block is used. The essence of this procedure is that the needle is being advanced under x-ray or ultrasound control down to the site of the nerve providing for the sensitivity of the joint, and a small amount of local anesthetic is injected. If this block decreases the level of pain significantly, then we can assume that most probably the pain syndrome is caused by the facet joints lesion.


Conservative treatment - non-steroidal anti-inflammatory drugs and muscle relaxants are used to relieve concomitant muscle spasm.

Interventional treatment - prolonged (more than 1.5 to 2 months) and severe pain syndrome is an indicaiton for radiofrequency denervation of facet joints. The essence of this procedure is that the nerves providing for the innervation of the facet joints are exposed to heat, which results in loss of ability to conduct pain impulses. The procedure lasts about 1 hour. In 20-30 minutes after the procedure, the patient can leave the clinic. The effectiveness of the procedure is high enough in most cases, patients report a decrease in pain intensity by more than 50 percent. Complications are extremely rare; they include increased pain in the affected segment in the first 10-14 days after the procedure.