Facet Pain

Defined: Back pain or neck pain originating from an abnormal spinal facet joint(s)

Prevalence: a common cause of back pain and neck pain

Pain Source: abnormal spinal facet joint(s)

Causes: inflammation in facet joint; facet arthropathy; spinal instability

Contributing factors: trauma to facet, genetics and arthritis in facet joint

The spinal facet joint is a weight bearing structure that acts as a “hinge joint” between two adjacent bony spinal vertebrae. Normally, the facet joint facilitates painless movement between the adjacent spinal vertebrae. Only when the spinal facet joint is injured can it become painful. Pain originating from a damaged spinal facet joint is called facet pain. Facet pain is usually worse with activities that cause movement of the spine such as bending, twisting and lifting. Facet pain lasting longer than 2 weeks usually will not go away on its own and requires treatment. If an abnormal disc is present, it is not possible to differentiate between discogenic pain and facet pain without either a discogram or facet blocks. Facet pain may mimic a pinched nerve with pain radiating into an extremity. The innervation of the facet joint is the medial branch of the dorsal ramus.

A diagnosis requires thorough medical history, physical exam, MRI, and possibly a discogram or facet/medial branch blocks.

Treatment depends on duration and severity of facet pain. Facet pain may respond well to a short course of pain medication, therapy and facet joint injections. Facet pain refractory to these treatments usually requires rhizotomy to effectively relieve painful symptoms. Rhizotomy is destruction of the small nerve to the facet joint. Facet medial branch rhizotomy is the most effective procedure designed to treat this condition and should be combined with therapy to optimize results and durability. Older, more invasive treatments include spinal fusion.

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