Facet Joints or Zygapophysial Joints: These are synovial joints connecting bones of spine together at the posterior or back portion of spine. Their function is to withstand weight and limit motion between each vertebra in the spine. Every spinal segment contains two facet joints.(1)
About Facet or Zygapophysial Joints
Facet joints promote control of movement at every segment of the vertebra. This is dependent on vertebral angles and orientations. The spine of a human body has various angles and orientations at every level changing movement in a specific area. The facets contain a layer of articular cartilage, which covers it and an articular capsule, which helps in movement and promotes stability. Nerve supply of facet joints is from two levels, one stems from nerve root at that level and second stems from a level just above it. Accurate functioning of the nerves promotes unrestricted movement of facet joints and good control of spine motion.
Causes of Facet Joint or Zygapophysial Joint Pain
Facet joint pain can be as a result of inflammation of joint or an impinged nerve. A disease of the facet joint is a common cause for low back issues. The spinal vertebra is connected together by facet joints whose function is to promote flexion, rotation, twisting and extension of spine. In cases of breakdown or as a result of degeneration, they get arthritic resulting in facet joint pain.(2)
Some Of The Causes Are As Follows:
- Wearing up of joints
- Compromised immune system
- Injury resulting in bone fracture
- Genetic predisposition
- Wrong lifting techniques
- Postural problems
Symptoms of Facet Joint or Zygapophysial Joint Pain
- Pain in back.
- Spasm in adjacent muscles resulting in guarded postures.
- Being unable to get back up after bending.
- Sudden onset of back pain.
- Restricted movement.
The spasm in adjoining muscles is type of a defense mechanism of body, so as to protect that region and restrict motion to prevent greater damage. The symptoms differ from individual to individual and more often than not are misinterpreted with other disc related problems. The usual facet locking disease can be treated successfully by liberating the joint responsible for it and restoring normal functionality. This needs to be performed after diagnosis is established.
Treatment for Facet Joint or Zygapophysial Joint Pain
- For acute stage, adequate rest is needed.
- Comfortable position is needed while resting to free up the joint.
- Hot or cold packs.
- Activity modifications.
- Anti-inflammatory medications to reduce pain and help with inflammation.
- After a couple of days of rest, gradual return to activities.
- Once acute stage passes, sports massage is performed to help with muscle spasm.
- Chiropractic therapy or osteopathic manipulation helps with stiffness of joints and allows decent motion of joints.
- Exercise strengthens back and core muscles as well as helps with correction of posture.
- For cervical facet joint issues, a restraining collar or cervical traction is beneficial. Supportive pillow can also be helpful.
- NSAIDs are beneficial for reduction of pain as well as swelling. Analgesics or muscle relaxants can also be used.
Surgical Treatment for Facet Joint or Zygapophysial Joint Pain
Procedures like radiofrequency rhizotomy/radiofrequency neurotomy can be done for de-nerving facet joint. These procedures become necessary when there is persistence of pain which is not relieved by conservative management. For this procedure, a special x-ray is fixed to a monitor so as to correctly place the needle having a small electrode inside facet joint. Then, current is passed so as to obliterate sensory nerves of joint resulting in pain relief.