To understand what is facet joint syndrome, one must first understand where it is located. The facet joint is located between two vertebrae in the spine. It is the joint that allows the back to be flexible and lets it bend and twist. There are also nerves of the spinal cord that exit through facet joints. In a healthy joint, the cartilage and synovial fluid that lubricates the joints allow the spine to move smoothly without too much grinding.
Facet joint syndrome can occur due to several factors including increased age, overload on joints (can be excess weight and occupation), or injury. These factors cause the discs between the vertebrae to degenerate and may eventually collapse leading to the narrowing of space. The excessive pressure on the surface of the face joint leads to more damage and bone is left to grind on bone. Patients will have pain when there is a movement that involves the spine.
Surgery is usually only considered as an option when conservative treatment options can no longer help the patient. Traditional open surgery for facet joint syndrome can be complicated as it requires a large incision with a higher risk of postsurgical complications. It also involves a longer recovery and rehabilitation process.
Minimally invasive spinal surgery for facet joint syndrome lowers complication rates and can be performed as an outpatient procedure, allowing patients to return to the comfort of their own homes on the day after the surgery itself. Procedures for facet joint syndrome includes any minimally invasive decompression surgery such as:
- Facet thermal ablation: This surgery deadens the nerves that are inflamed due to arthritis.
- Discectomy: This procedure aims to remove the part of the disc that is causing compression.
- Laminotomy: Pressure on the spinal cord is reduced by surgery.
- Foraminotomy: A procedure to relieve pressure on nerves.
If the disease has progressed to the point where stabilization of the spine is necessary, stabilization procedures should also be performed. They include:
- Anterior cervical discectomy fusion: Only for the cervical spine (neck), the damaged disc is replaced by a transplant or bone graft.
- Cervical disc replacement: Just like the procedure above, an artificial disc substitutes the damaged disc in the neck region.
- Posterior cervical fusion: A fusion surgery done on the back of the neck to stabilize it.
- Transforaminal lumbar interbody fusion (TLIF): Specific for the lower back, a bone graft and spacer is inserted to maintain height and stability.
- Lateral lumbar interbody fusion: The spine is accessed from the side of the body so separation of the lower back muscles can be avoided.
- Sacroiliac joint fusion: The joint where the sacrum meets the pelvis is fused for stability.
After these surgeries, it is recommended that patients should go through a physical therapy or rehabilitation course to improve recovery rates and reduce complications. Surgery should be considered a last resort as conservative treatments such as physical therapy, pain medication, heat packs and ice therapy is usually sufficient for the majority of patients.
- Perry M. Is facet syndrome surgery my only option? Laser Spine Insitute. Accessed 6/21/2017. https://www.laserspineinstitute.com/back_problems/facet_syndrome/treat/surgery/
- Facet joint syndrome. All About Back & Neck Pain. Accessed 6/21/2017. https://www.depuysynthes.com/patients/aabp/understandingconditions/facetjointsyndrome