CAUSES OF CHRONIC BACK PAIN: Facet Syndrome

Anatomy

The vertebrae are the "bony elements" that surround the spinal cord. In an adult human, there are approximately 25 bones that make up the spine. 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back) and 1 sacral ("tailbone"). The vertebrae are composed of several elements: vertebral body, pedicles, lamina, transverse process, spinous process & superior/inferior articular processes (which make up the facet joint). The vertebral body is a "hourglass" shaped bone which we commonly associate with the spine. The pedicles and lamina make up the posterior "ring" of the vertebrae which is responsible for housing the spinal cord. The transverse processes are sites for muscle/ligament attachment and rib attachment (in the thoracic spine). The spinous process is the bony "bump" you can feel on your back, this is also a site for muscle/ligament attachment. The superior & inferior articular processes form the posterior joints called the facet joints. The facet joints help guide motions in our spine such as bending forward/backward, bending sideways and turning from side to side. Like any other joint in your body, the facet joints are covered with a layer of cartilage, surrounded by a joint capsule (made of ligaments) and bathed in a lubricating fluid called synovial fluid.

Condition: Facet Syndrome

Facet syndrome, as it is typically called, is type of arthritis that is specific to the facet joints (comprised of superior & inferior articular processes of vertebrae) in the posterior aspect of the spine. As the name implies, it is a "syndrome" which consists of several symptoms with multiple interlinked causes. The cause of facet syndrome is largely unknown but it is thought to occur due to (1) Hyperlordosis (hyper-extended lumbar spine) which pinches on a pain sensitive meniscoid tab (which is like a little piece of cartilage) or (2) Degeneration of the joints causing laxity (loosening) of the joint capsule which can lead to a type of spinal stenosis called lateral canal stenosis. Lateral canal stenosis can cause "pinching" of the nerve at the intervetebral foramin where the spinal nerves exit your spinal cord to "innervate" or attach to the extremities (legs/arms) causing arm/leg pain and/or numbness/tingling. Further degeneration of the facet joints can cause bony outgrowths in the spine called osteophytes or "bonespurs". This can lead to another type of spinal stenosis called central canal stenosis. When this occurs, it is not the spinal nerves that are "pinched" (as in lateral canal stenosis), it is the actual spinal cord. Central canal stenosis can cause a variety of symptoms depending on its location. In essence, facet "syndrome" is due to several aspects:

(1) "Jamming" of the facet joints causing "pinching" of the small pain sensitive mensicoid tabs within the facet joints or
(2) Degeneration of the facet joints which can lead to lateral canal stenosis
causing:
i.) "Pinching" of the spinal nerves as they exit the intervertebral foramin of
the vertebrae. These nerves innervate ("connect to") the skin and
muscles in your extremities (arms/legs) which can cause pain/
numbness/tingling in the extremities.
(3) Further degeneration of the facet joints can lead to central canal
stenosis causing:
i.) "Pinching" of the actual spinal cord.

Diagnosis: Facet Syndrome

Facet syndrome can be accurately diagnosed with a proper physical examination. X-rays can be helpful to view the facet joints to determine if there is any significant "pressure" on them. Facet joints can also be injected with a pain relieving substance to help determine if this is the primary cause of back pain. For more advanced cases, usually other co-morbidities ("conditions") are contributing to the pain such as spinal stenosis, arthritis of the spine and degenerative joint disease. In these cases, more advanced imaging such as a MRI/CT scan may be required.

Treatment: Facet Syndrome

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID's), Physical/Chiropractic Therapy, Injections or Surgery. NSAID's have an inherent risk of Gastrointestinal ("stomach" and "intestines") disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in the New England Journal of Medicine reported that it has been conservatively estimated that 16,500 NSAID-related deaths occur every year in the United States and conservative calculations estimate that approximately 107,000 Americans are hospitalized every year due to NSAID related GI complications. The number of deaths reported in the same study due to AIDS was 16,685. In addition to Gastrointestinal disorders, drugs such as VIOXX have been known to cause serious Cardiovascular (CV) events such as: Heart Attacks, Stroke and Heart Failure. There have been similar complaints from other NSAID's such as: Bextra and Celebrex.

Facet joint injections can relieve pain caused by inflammation in the facet joints but this relief is temporary. Minor surgical procedures have recently been developed to "destroy" the nociceptive (pain sensing) nerves that attach to the facet joint, however, research indicates that these particular nerves can regenerate within months thus necessitating the need for further treatments.

In extreme cases, with co-morbidities present, surgical intervention is aimed at removing the facet joints at each level of pain and "fusing" the spine together. A study to determine the effects of single level (2 vertebrae) and 2-level (3-4 vertebrae) spinal fusion success rates reported 53% with "good" and "fair" results with single level fusion and no "good" results with 2-level fusions. This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Now that you have read about the possible side effects of what traditional treatments have to offer, you may want to consider the drugless, non-surgical approach that Non-Surgical Spinal Decompression has to offer.

Non-Surgical Spinal Decompression: Facet Syndrome

The following is the rationale based on anatomical and physiological principles of Non-Surgical Spinal Decompression. Non-Surgical Spinal Decompression offers to treat the root cause of the disease - compression of the facet joints and a narrowing of the intervertebral foramin. When the pressure is relieved from the disc, it is called Non-Surgical Spinal Decompression. When pressure is relieved from the joints, it is called Spinal Distraction. You cannot have one without the other. Non-Surgical Spinal Decompression, or "distraction", of the facet joints can alleviate the pain in several ways. Distraction, or "widening", of the facet joints can relieve the pressure from the pain sensitive meniscoid tab which can be "pinched" causing localized pain. Once the pressure is removed from the mensicoid tab within the facet joint, pain is often eliminated. In some instances when the facet joints are "jammed together", the intervertebral foramin (the opening from which the spinal nerves exit the spinal cord) is narrow (like a small circle). As a result, the spinal nerves become "pinched" in this bony "circlular" opening causing extremity (arm/leg) pain and/or numbness/tingling. Non-Surgical Spinal Decompression causes distraction of the vertebral joint thus converting the small, narrowed, circular intervertebral foramin into a larger, oval shaped intervertebral foramin in which the spinal nerves have ample room to exit the spinal cord without being "pinched".

Thus, Non-Surgical Spinal Decompression for facet syndrome is based on the following principles:

(1) When decompression occurs at the level of the disc, distraction
occurs at the level of the facet joint.
(2) Distraction (widening) of the facet joints can relieve pressure
from the pain sensitive meniscoid tab that may be "pinched"
(3) This causes a relief of local symptoms

While at the same time:

(4) Distraction of the facet joints causes a widening of the
intervertebral foramin (the opening where the spinal nerves
exit the spinal cord)…
(5) Pressure is relieved from the spinal nerves exiting the from
the spinal cord as the small, circular, "bony" opening is widened
to form a larger, oval shaped "bony" opening.
(6) Since the spinal nerves innervate (attach to) the skin and
muscles of the extremities (arms/legs), the pain and/or numbness
in these areas can be decreased or eliminated.