This condition refers to back pain with an origin of mechanical joint pain in the absence of disc pathology. The facet joints are the posterior elements of the vertebrae which make up the dynamic motion afforded to us in the spine. There are a pair of superior facet joints oriented to communicate with the inferior facets of the vertebrae above and another inferior pair of facet joints designed to communicate with the superior facets of the vertebrae below. The facet joints are synovial joints which like any other synovial joint are susceptible to wear and tear changes, degeneration and arthritis.

thoracic vertebra side view
thoracic vertebra overhead view

The joints are also surrounded by a thick fibrous capsule which is highly innervated with nerve fibers from the posterior rami of the nerve from the same level and the level above. Not only do these nerves innervate the capsule, but also the facet themselves along with the smaller muscles of the lumbar spine such as the multifidus, interspinous muscles and interspinous ligament. This is one reason why back pain can be broad, diffuse and vague. Facet joint pain can be caused from malalignment of the joints, instability, joint fixation, or loading or stress of the joints especially when the capsule is stretched or buckled.

The functional unit of the spine is comprised of two adjacent vertebral bodies separated by the disk and the posterior structures of the vertebrae or simply the joints. In a functional unit, the superior joints of one vertebrae articulate or move in parity with the inferior joints of the vertebrae above and inferior joints articulate with the superior facet joints of the vertebrae below. Sounds complicated right? It certainly is. The more complicated a structure the more volatile it remains. The structures and joints of the spine are highly dynamic and require near perfect harmony for them to function in the absence of pain. Just like your car does not work 100% of the time and requires maintenance to keep it running, so does your spine to remain healthy and pain free. The reason that statistically 90 percent of Americans will experience lower back pain at some point in their lives is because of the inherent intricacies of the functional units of our spine.

As in degenerative disc disease the disc between the vertebrae begins to thin causing the facet joints behind the disc to move closer together. This proximity increases the load factor of the joints and can cause facet hypertrophy. This is characterized by swelling of the joint and associated capsule which, if it becomes severe enough, can irritate the nerve roots at that particular level. When nerve roots are irritated and inflamed, this process communicates through the body via the spinal cord and brain which may turn on the guarding mechanism of muscular spasm.

Facet Syndrome can be very complicated and it is very important to have a health care professional rule out more serious conditions as lower back pain has a variety of causes.

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