Anatomy of the spine
The lumbar spine (lumbar spine) is formed by the five lumbar vertebrae of the spinal column. Since they are located in the lower part of the spine, they must bear the highest proportion of weight. For this reason, they are also considerably thicker than the other vertebrae.
However, this does not prevent the signs of wear and tear that are particularly common in this area. For example, joint wear and slipped discs are most common in the lumbar spine. Each vertebral body has two upper and two lower vertebral joints.
These create the connection to the next upper or lower vertebral body, which in turn has the same joint processes. Depending on the alignment of the vertebral joints and the structure of the vertebral bodies, different degrees of movement are possible for the respective spinal column section. The overall mobility of the spinal column is large, although only relatively small movements are possible between the individual vertebral bodies.
Summing up these small ranges of motion ultimately results in the large range of motion. The greatest range of motion is found in the cervical spine (cervical spine), especially in the lower cervical vertebrae, due to the almost horizontal alignment of the small vertebral joints. Movements in all directions are easily possible.
The range of motion of the thoracic spine (thoracic spine) is small, due to the special structure of the vertebral bodies and the attachment of the ribs. The main movement of the thoracic spine takes place in the lower thoracic spine region when the upper body is rotated. In the lumbar spine, mainly bending and straightening movements and lateral movements are possible. Due to the special structure of the vertebral body and the alignment of the vertebral joints (anterior/posterior), there is hardly any rotational movement.
How does a facet syndrome develop?
The pathogenesis of facet syndrome must be seen in conjunction with other degenerative spinal diseases. The wear and tear of the intervertebral discs already begins in the twenties of a person. It can lead to a bulging or a herniated disc (nucleus pulposus prolapsus).
The increasing water loss of the intervertebral disc leads to a decrease in height of the intervertebral body section (osteochondrosis). The consequences are an overload of the small vertebral joints, a malfunction of the spinal ligaments and a creeping instability of the so-called spinal motion segment (consisting of two vertebral bodies and the intervertebral disc between them). The base and top plates of the vertebral bodies are subjected to more stress due to the lowered intervertebral disc.
The body reacts to this by compressing the bone in the area of these structures (sclerotherapy), which can be seen on X-rays. The body tries to counteract the instability of the spinal column by producing bony attachments to the vertebral bodies (osteophytes/exophytes), which seek support in the surrounding area. In very advanced instability, a wear-related curvature of the spine can develop, further weakening the static of the spine (degenerative scoliosis).
As the facet syndrome progresses, the spinal column statics change. The points of origin and attachment of the muscles and ligaments of the spinal column change, with some muscles and ligaments becoming too close and shortened and others being stretched considerably. Both of these changes lead to the weakening of these structures through the loss of function.
Painful muscle hardness (muscle hard tension/myogelosis) can develop.An incongruent (not congruent) position of the vertebral body joints in relation to each other leads to premature cartilage abrasion of the joint partners. The same processes that are well known for knee or hip joint arthrosis then take place. In facet syndrome, joint inflammation, capsule swelling and thickening occurs, and even more quickly than in the large joints, joint deformation occurs.
The overall picture of a vertebral joint arthrosis (spondylarthrosis) has emerged. Instability-induced shifts in the vertebral bodies (pseudospondylolisthesis), thickening of the vertebral joint structures, bony spinal canal attachments, disc protrusions and thickening of the vertebral ligaments (ligamentum flavum) can ultimately lead to a considerable narrowing of the spinal canal (spinal canal stenosis) and pressurize the spinal cord itself or the outgoing nerve roots. Recessus stenosis refers to a pressure on the nerve root in the lateral recessus (lateral area of the spinal canal), usually caused by degenerative changes in the upper vertebral joint process in facet syndrome (superior articular process).
