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Facet syndrome

Facet syndrome occurs when the zygapophyseal joints (Z-joints) from the second cervical vertebra in the neck (C2) to the first sacral vertebrae in the lower back (S1) cause pain. The Z-joints, which are commonly called facet joints, are a pair of joints on the back of the spine. Facet syndrome can progress to spinal osteoarthritis, also known as spondylosis.

Common Symptoms

Cervical Facet Syndrome

  • Tenderness to touch of the joints and muscles of the neck
  • Pain when you extend or rotate the neck
  • Headaches
  • Limited range of motion
  • A dull, aching discomfort in the back of the neck


Lumbosacral Facet Syndrome

  • Abnormal gait
  • Pain with extension from a flexed position
  • Leg pain
  • Muscle spasm
  • Back pain that feels deep and achy


Diagnosis

Your doctor will take a basic history, focused on the activities that cause or relieve pain, and perform a physical exam. You’ll be asked about the location of the pain, whether it is isolated or radiating and the intensity and frequency. Imaging studies, such as MRI, CT and x-rays, are often used to rule out other sources of pain like fractures or tumors.

Treatment

Physical therapy is the first line of treatment, with a goal of reducing pain and inflammation. Therapeutic modalities such as ultrasound and electrical stimulation may also reduce painful muscle spasms, and manual therapy, joint mobilization, soft-tissue massage and muscle stretching are often helpful.

Medial branch blocks temporarily interrupt the pain signal from the medial branch nerves that supply a specific facet joint. Patients who respond to the blocks may be candidates for radiofrequency neurotomy, an injection procedure that creates a lesion on the nerves to interrupt pain signals to the brain.

The benefits of surgery should always be weighed carefully against its risks. Cervical fusion is a surgical procedure that should be considered with caution and only after aggressive nonsurgical care has failed.

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