Brief overview
- Causes and risk factors: Often age-related wear and tear; overuse from sports, heavy physical labor, or obesity increase risk. Disc disease, scoliosis, osteoporosis, other possible causes.
- Symptoms: Back pain that cannot be precisely localized, often worse during the day and with exertion. Morning stiffness of the spine. Radiation to legs or neck possible.
- Treatment: painkillers, physiotherapy, back training. Under certain circumstances, sclerotherapy of the nerves or surgery.
- Prognosis: With sustained therapy, the symptoms, especially the pain, can often be alleviated. Only rarely does the pain remain chronic.
- Prevention: Back problems can be prevented, at least to some extent, with balanced regular exercise. Certain gentle work techniques may prevent occupational diseases.
What is facet syndrome?
The reason for the wear and tear is, for example, wear and tear due to age, heavy physical activity or long-term overweight. In some cases, the intervertebral discs are also affected by the symptom complex.
As early as 1911, doctors discovered the facet joints as a possible cause of back pain. Some experts suspect that the facet joint is at least involved in around 80 percent of vertebral pain – and is therefore often the reason for visits to the doctor for back pain.
Depending on the location of the damage, a distinction is made between lumbar, cervical and thoracic facet syndrome. The most common is lumbar, in which the lumbar spine is affected. In cervical, the cervical spine is affected, and in thoracic facet syndrome, the thoracic spine is affected.
Anatomy: What are facet joints?
The spinal column consists of 33 vertebrae. The vertebrae each consist of a vertebral body, which is joined at the back by the vertebral arch. The vertebral arch encloses the spinal cord. The intervertebral discs sit between the vertebral bodies like small cushions. They provide the distance between the vertebrae, absorb shocks and, above all, allow the vertebrae to move against each other.
Causes and risk factors
The cause of facet syndrome is considered to be wear-related damage to the vertebral joints. Age-related joint wear is the most common cause. However, this vertebral joint osteoarthritis is also favored by excessive stress, for example, through sports, heavy physical work or prolonged overweight as risk factors. Damage caused by accidents or back surgery in the past is also possible.
Another possible cause is cysts or so-called ganglions near the facet joint. A ganglion is a growth of connective tissue. It usually develops in areas subject to high stress, i.e. primarily in the lumbar vertebrae (lumbar facet syndrome). Women are affected somewhat more frequently. It is a particularly painful form of the disease.
Other possible causes of facet syndrome are blockages of the vertebrae, instability of the joint or reflex muscle tension, which often results from overloading or instability of the spine.
Less frequently, tumors or malformations of the spine that have existed since birth are also the cause of facet syndrome.
Is facet syndrome recognized as a severe disability?
With appropriate treatment, there is usually no need to recognize a degree of disability (GdB) – that is, a severe disability. This is only necessary in individual cases and very rarely if the facet syndrome remains chronic with persistent pain.
In some cases, a degree of disability of up to 20 percent has been recognized. However, this is not a guideline value, but depends on the individual case.
How does a facet syndrome manifest itself?
In addition, hip complaints and even leg cramps are possible in the context of facet syndrome. The pain then possibly radiates into the legs and intensifies when the spine is overstretched. But the pain also increases when the spine is strained. Overall, the symptoms of facet syndrome often lead to severe limitations in daily life if left untreated.
Examinations and diagnosis
- Where is the pain strongest?
- Does the pain last permanently (continuous pain)?
- Have you had previous episodes of pain?
- What treatments have been tried?
- How much does the pain affect your daily life?
- Are there any particular triggers?
- Do you have any other accompanying complaints?
- Are you currently experiencing psychological distress?
In addition, standardized pain questionnaires are often used.
At the same time, however, there are usually no abnormalities of the nervous system (neurological abnormalities) such as reflex deficits, sensory disturbances or paralysis. The presence of such symptoms would be a warning sign of other spinal disorders such as a herniated disc or severe spondylolisthesis, in which individual vertebrae shift forward or backward.
Another method of detecting a facet syndrome is the tentative injection of local anesthetics into the joint area (diagnostic facet blockade). This numbs certain nerves (ramus dorsalis of the spinal nerves). This is where pain signals are normally carried. The injection should be done under the control of an imaging procedure such as CT or MRI.
Treatment
Initially, one usually tries to treat the facet syndrome with conservative (non-surgical) methods. Experts believe that pain relief can be achieved not only through rest, but also through certain forms of exercise such as physiotherapy.
The exercises aim to strengthen the muscles on the one hand, but also to stretch them and improve their coordination on the other. Patients learn how to manage and combat pain.
Another treatment option is to inject a local anesthetic with or without cortisone near the facet joint or directly into the joint. This facet infiltration must be placed very precisely. Therefore, the practitioner controls the position of the injection needle by means of imaging.
If the symptoms of facet syndrome persist despite conservative therapy methods, surgery is also possible, in which a section of the spine is stiffened or spacers are implanted between the vertebral bodies, for example.
Course of the disease and prognosis
The prognosis of facet syndrome and the chance of freedom from pain depend primarily on the spinal changes that underlie the syndrome. Often, sustained relief of pain can be achieved through consistent therapy. This and a good quality of life are the main goal of therapy for facet syndrome.
How long one may be unable to work with facet syndrome or whether one is able to work despite the pain depends on the individual symptoms and the appropriate treatment. General statements cannot be made about this.
Prevention
Age-related wear and tear can only be prevented to a certain extent. Avoiding excess weight and one-sided stress is helpful.
When carrying heavy loads and doing heavy physical work, there are many techniques and aids that relieve strain and are easy on the joints – which, for example, prevents occupational illness and loss of working hours.
