Back Pain Due to Facet Joint Compression

The facet joints of the spine lock the vertebrae together, holding the spine erect but allowing a complex range of movements:

• Flexion (bending forward)
• Extension (bending backwards)
• Bending from side to side
• Rotation, clockwise or counter-clockwise

If the joints become compressed, the vertebrae no longer move freely and you become stiff and there is decreased flexibility of the spine.

If the cartilage which covers the surface of the facet joints becomes worn, you can no longer move your head or lower body smoothly and without pain. The stiffness gradually worsens and can lead to spinal osteoarthritis. Occasionally, to make up for the weakening joint, the body may begin to produce bone spurs, called osteophytes. These bone spurs worsen the problem, as they may project out from the facet joint, protruding into the spinal canal, pinching nerves.

If a bone spur projects from the facet joint and presses upon a disc, which is the tough cartilage cushion between each vertebrae, there can be trouble. The spur may cause the disc to bulge out into the spinal canal, pinching nerves, and often causing low back pain or sciatica symptoms. Sufficient pressure from the bone spur may even cause the disc to herniate.

Another cause of back pain can develop when the nerves of the spinal cord leave the vertebral column. First, it is necessary to understand the formation of the vertebrae. Each has a large opening in the center, called the foramen, through which the spinal cord runs. The vertebrae are stacked one on top of another to make up the spinal column. When two vertebrae are locked together by the facet joints, there is a small opening formed on the side of the spinal column. It is not present in a single vertebra and two are required to make a single opening. This is known as an intervertebral foramen and the nerves branching off the spinal cord exit the vertebral column through these holes. If the facet joints become compressed, the intervertebral foramen becomes smaller, reducing the space through which the nerves must exit. This leads to nerve root compression, known as impingement.

The effects of facet joint compression can be wide reaching, leading to:

Referred pain

Organ dysfunction

Tingling and numbness in affected extremities.

Once a diagnosis has been made, there are a variety of treatments to alleviate pain:

• NSAIDS, non-steroidal anti-inflammatory medication such as ibuprophen or naproxyn are helpful.
• Physical therapy may improve mobility, range of motion, and strength.
• Corticosteroid and local anesthetic may be injected into the joint to relieve inflammation.
• Blocking the dorsal medial nerve branch that innervates the inflamed joint may be effective.
• Fusion of the joint has been discussed but there are no published reports of this type3 of treatment.
• New procedures for the surgical removal of bone spurs have been effective.

Patients need education about every aspect of this problem and should be informed of all treatment options. It is very important that they use good body mechanics to prevent worsening of their symptoms.