Facet Joint Syndrome
Facet joints or zygapophysial joints are formed as a result of the superior and inferior articular processes of adjacent vertebral bodies in the posterolateral vertebral column from the cervical to the lumbar spine.
The main function of these joints is the restriction of spinal flexion, extension and axial rotation in segmental movements whilst providing support and stability to the overall spinal column.
A review published in the Journal of Biomechanical Engineering by Jaumard et al. provides a comprehensive overview of the anatomy of the facet joints in addition to the mechanical loading response of the soft and hard tissues that these joints are composed of.
The bony articular pillars of the lateral mass are aligned in the form of two posterolateral columns that provide mechanical support during axial loading along the spine, in conjunction with the anterior column of vertebral bodies that are connected by intervertebral discs.
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The articular surfaces of the facet joints are covered with an avascular layer of hyaline cartilage which varies in thickness to provide for the frictionless motion between adjacent vertebra whilst absorbing compressive loads from shearing and axial forces to the spinal column.
Facet Joint Syndrome is a broader term that encompasses any dysfunction or abnormality in the facet joints that causes chronic pain in the lumbar spine, which intensifies upon rest and improves by motion, particularly in the mornings.
A gradual degeneration of the tissues in the facet joints occurs over time leading to altered mechanical functionality with significant neurologic implications; this mainly stems from a loss of the cushioning cartilage surface layer which increases frictional stresses during vertebral motion and causes inflammatory cytokines to leak into the intraspinal space.
The onset of conditions such as osteoarthritis or spondylolisthesis can facilitate the formation of synovial cysts that cause acute radicular pain because of compression of the nerve root or the thecal sac.
In its acute phase, treatment modalities for facet joint syndrome should focus on relief from pain and discomfort by following a passive to active care routine that consists of rest as needed, cryotherapy and mobilisation exercises.
Postural correction forms an important component of any long-term pain relief programme for facet joint syndrome because of the reduction of any extra stress on the injured/affected joints in addition to the treatment of lumbar lordosis.
With improvements in gait mechanics and subsequent improvements in sagittal plane blockages, chronic pain associated with spinal conditions can be alleviated with significant corrections in foot posture and the optimal re-alignment of the musculoskeletal system.
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References:
- Jaumard V. N., Welch C. W., Winkelstein A. B. (2011) Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions. Journal of Biomechanical Engineering: July 2011, Vol. 133, No. 7, doi: 10.1115/1.4004493.
- Malanga A. G., Memmo P., Young C. C., Perron D. A. (2016) Lumbosacral Facet Syndrome Treatment & Management. Retrieved from: http://emedicine.medscape.com/
- Boos N., Aebi M. (2008) Spinal Disorders: Fundamentals of Diagnosis and Treatment. Springer Science & Business Media.
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