Facet syndrome

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Facet syndrome
Classification and external resources
ICD-9-CM 716.88, 721.0,721.3

Facet syndrome, also commonly known as facet joint disease, facet osteoarthritis, facet hypertrophy or facet arthritis is a syndrome in which the facet joints (synovial diarthroses, from C2 to S1) degenerate to the point of causing painful symptoms.[1] In conjunction with degenerative disc disease, a distinct but functionally related condition, facet syndrome is believed to be one of the most common causes of lower back pain.[2][3]

Pathophysiology[edit]

55% of facet syndrome cases occur in cervical vertebrae, and 31% in lumbar. Facet syndrome can progress to spinal osteoarthritis, which is known as spondylosis.[4] Pathology of the C1-C2 (atlantoaxial) joint, the most mobile of all vertebral segments, accounts for 4% of all spondylosis.[5]

Facet Joints[edit]

The facet joints are formed by the superior and inferior processes of each vertebra. The first cervical vertebra has an inferior articulating surface but, as it does not restrict lateral or posterior translation, is not always considered a proper zygoma[6][7] (zygoma is Greek for "yoke," i.e. something that restrains movement). In the lumbar spine, facets provide about 20 percent of the twisting stability in the low back. Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation.

Facet joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful muscle spasm.

Cause[edit]

Like many other joints throughout the human body, facets can experience natural degeneration from constant use. Over time, the cartilage within the joints can naturally begin to wear out, allowing it to become thin or disappear entirely which, in turn, allows the conjoining vertebrae to rub directly against one another with little or no lubricant or separation. A result of this rubbing is often swelling, inflammation or other painful symptoms.

Over time, the body will naturally respond to the instability within the spine by developing bone spurs, thickened ligaments or even cysts that can press up against or pinch the sensitive nerve roots exiting the spinal column.[8][9]

While primarily caused through natural wear and tear, advanced facet syndrome can also occur as a result of injury to the spine, degenerative disease or lifestyle choices. These causes can include:

Symptoms[edit]

The symptoms of facet joint syndrome depend almost entirely on the location of the degenerated joint, the severity of the damage and the amount of pressure that is being placed on the surrounding nerve roots.[10] It's important to note that the amount of pain a person experiences does not correlate well with the amount of degeneration that has occurred within the joint. Many people experience little or no pain while others, with the exact same amount of damage, undergo chronic pain.

Additionally, in symptomatic facet syndrome the location of the degenerated joint plays a significant role in the symptoms that are experienced. People with degenerated joints in the upper spine will often feel pain radiating throughout the upper neck and shoulders.[9] That said, symptoms primarily manifest themselves in the lumbar spine, since the strain is highest here due to the overlying body weight and the strong mobility. Affected persons usually feel dull pain in the cervical or lumbar spine that can radiate into the buttocks and legs. Typically, the pain is worsened by stress on the facet joints, e.g. by diffraction into hollow back (retroflexion) or lateral flexion but also by prolonged standing or walking.

Pain associated with facet syndrome is often called "referred pain" because symptoms do not follow a specific nerve root pattern and the brain can have difficulty localizing the specific area of the spine that is affected. This is why patients experiencing symptomatic facet syndrome can feel pain in their shoulders, legs and even manifested in the form of headaches.[11]

Diagnosis[edit]

Facet syndrome can typically be diagnosed through a physical examination, MRI, x-rays and/or a diagnostic block into the suspected joint.[11]

Facet syndrome has no specific code in ICD-10. It can be diagnosed as “other” in M53.8 – other specified dorsopathies.[12]

Treatment[edit]

In general, anti-inflammatory drugs are prescribed initially. This medical treatment is usually accompanied by physiotherapy to increase back and stomach muscles. Thus, the spine can be both relieved and stabilized.[13] If these conservative measures do not bring about betterment, minimally invasive procedures such as a facet infiltration can be conducted to offer relief. In this procedure, a local anesthetic is injected directly into the respective joint, usually in combination with a cortisone preparation (corticosteroid).[14]

See also[edit]

References[edit]

  1. ^ Emedicine article on Lumbosacral Facet Syndrome
  2. ^ Kalichman, Leonid; Li, Ling; Kim, David H.; Guermazi, Ali; Berkin, Valery; OʼDonnell, Christopher J.; Hoffmann, Udo; Cole, Rob; Hunter, David J. "Facet Joint Osteoarthritis and Low Back Pain in the Community-Based Population". Spine. 33 (23): 2560–2565. doi:10.1097/brs.0b013e318184ef95. 
  3. ^ Suri, P.; Hunter, D.J.; Rainville, J.; Guermazi, A.; Katz, J.N. "Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults". Osteoarthritis and Cartilage. 21 (9): 1199–1206. doi:10.1016/j.joca.2013.05.013. 
  4. ^ ICD-10 www.icd10data.com.
  5. ^ James Halla. "Atlantoaxial (C1-C2) facet joint osteoarthritis". 
  6. ^ Frank Netter. "Atlas of Human Anatomy". 
  7. ^ Van de Graaff (2002). Human Anatomy. New York: McGraw Hill, p. 160.
  8. ^ "Bone spurs Causes". Mayo Clinic. Retrieved 2017-09-20. 
  9. ^ a b Lim Jae, Y. MD (December 2016). "Facet Disease"Atlantic Brain & Spine. Retrieved 20 September 2017.
  10. ^ "Facet Joint Syndrome". www.cedars-sinai.edu. Retrieved 2017-09-20. 
  11. ^ a b "Facet Joint Syndrome - UCLA Neurosurgery, Los Angeles, CA". neurosurgery.ucla.edu. Retrieved 2017-09-20. 
  12. ^ Where is the ICD-10 code for facet syndrome? www.chirocode.com.
  13. ^ Facet Syndrome www.joimax.com.
  14. ^ A. Gangi, J. L. Dietemann, R. Mortazavi, D. Pfleger, C. Kauff, C. Roy: CT-guided interventional procedures for pain management in the lumbosacral spine. In: Radiographics. 18, 1998, S. 621–633.