Diagnosis

Back pain is a very common symptom that can have a variety of causes and is usually treated by a family doctor or orthopedic surgeon. In most cases, relatively harmless causes (e.g. age-related signs of wear) are responsible for the pain, which is why a physical examination in conjunction with the patient’s medical history (anamnesis) is usually sufficient to make a diagnosis of facet joint syndrome. This involves testing the mobility and sensitivity of the spine and back muscles.

The exact localization and intensification of pain during certain movements are very important for the diagnosis. Standardized pain questionnaires can be used for the exact recording and assessment of pain. In some cases it may be useful to perform imaging diagnostics.

An X-ray, CT or MRI (magnetic resonance imaging) can be taken to detect bony changes in the facet joints or other damage to the spine, such as a herniated disc. However, wear and tear of the joints, which can be shown on the images, does not necessarily have to be the cause of the complaints. This is due to the fact that wear and tear is an age-related phenomenon and even in people who are actually pain-free, signs of wear and tear can be seen in the images.

In order to prove that the pain is actually caused by the facet joints, an analgesic may be injected into the small joints under X-ray control. Facet joint arthrosis is considered to be proven if the affected person is pain-free for a while after the injection. The reliable exclusion of other diagnoses plays a decisive role in the diagnosis of back pain.

These include pain in the area of the facet joints such as herniated discs, spondylolisthesis or spinal stenosis. A vertebral fracture (fracture) may also be present, since in severe osteoporosis (bone atrophy) a bone or vertebra can fracture without further external influence. In addition, irritation in the sacroiliac joint (sacroiliac joint) or hip joint arthrosis can also lead to pain in the facet joints and must be excluded diagnostically.

Pain in the area of the facet joints can have a variety of causes. Depending on the trigger of the disease, surgical and non-surgical (conservative) therapy options are considered. As a rule, targeted training and strengthening of the trunk musculature as well as relaxation exercises are in the foreground.

It can be useful to learn the correct execution and the right amount of strengthening exercises under the guidance of a physiotherapist. Regular physical exercise in the form of jogging, cycling or swimming is also recommended in any case to prevent pain. Heat applications using infrared light or hot water bottles can also provide relief, as the warmed areas are better supplied with blood and healing processes can take place more quickly.

A similar effect can be achieved by relaxing massages, because the pain often leads to a relieving posture, which leads to additional tension of the muscles, which can be released by massage. Alternative healing methods such as magnetic field therapy or acupuncture are also used. Painkillers can support the treatment, often drugs like paracetamol or ibuprofen are used.For severe pain, stronger painkillers up to opioids can also be used.

A short-term and temporary freedom from pain can be achieved by injection therapy. This usually involves injecting a local anaesthetic and possibly a small dose of the anti-inflammatory agent cortisone into the facet joints. This measure can be useful, for example, if the pain is so severe that the person affected cannot move sufficiently.

However, since movement is one of the most important therapeutic measures, short-term freedom from pain can be achieved in this way, so that suitable rehabilitation training can be started. Only when the aforementioned measures have not led to an improvement in pain and it has been proven that the pain is actually caused by the small facet joints, more invasive procedures are used. One method, for example, is the so-called facet joint thermocoagulation.

Here, the small pain-conducting nerves are sclerosed by tiny punctures with a needle during a short minimally invasive procedure. This does not eliminate the cause of the pain (i.e. the signs of wear), but rather prevents the perception of pain by interrupting the transmission. Another therapy method is the use of so-called spreaders. A placeholder or spreader is inserted between the vertebrae in a minimally invasive way and is stretched. This reduces the pressure on the facet joints and, as a rule, reduces the pain.