Facet Joint Syndrome

The facet joints are the connections between the vertebrae of the spine. Just like the knee or elbow or any other joint in the body, they allow the spine to bend and twist. They are also stabilizing joints that prevent excessive motion and help hold the body upright.

The joints are on the back of each vertebrae and they link one vertebra to the vertebrae directly above and below to form a working unit that allows movement. The surfaces of the joints are covered with a tissue called the articular cartilage. The joint itself is lined with a membrane called the synovium and the joint is enclosed in a fibrous sac, the joint capsule. Synovial fluid, a thick liquid which acts like lubricating grease and surrounds the joint, allows the bones to move without friction.

When these joints become inflamed secondary to injury or arthritis, pain and stiffness occur. If the joints in the neck or cervical spine are affected, these symptoms develop:

• Headaches
• Pain in the neck, shoulders, and upper back.
• Difficulty rotating the head
• Patients often complain that they have to turn their entire body to look to the right or left.

When Facet Joint Syndrome affects the lower back, there is:

• Pain in the lumbar area
• There may be referred pain to the buttocks and thighs
• Stiffness of back
• Difficulty getting out of a chair
• Difficulty standing up
• Complaints that the patient must walk hunched over

An injury or changes associated with aging may cause the cartilage cushion that covers the bones to wear away, resulting in pain as the bones in the joint rub together. Also, small nerves that branch off the larger spinal nerves can become irritated or pinched, causing pain. Facet Joint Syndrome is more common in people over 50 and is usually associated with aging.

Causes of Facet Joint Syndrome

• Whiplash Injury can cause the syndrome in the cervical area.
• Sports activities,such as gymnastics, where neck is extended
• Arthritis
• Poor posture which pushes the spine out of alignment
• Inflammation
• Infection
• Degeneration of the joint
  

Diagnosing Facet Joint Syndrome

• History and Physical should be done
• An X-ray, CT (computerized tomography) scan of the spine or an MRI (magnetic resonance imaging) will rule out fracture or herniated disc.
• Facet joint block would determine if the joints are the source of pain.
• A local anesthetic is injected into or near the nerves that supply the joint. If there is a significant decrease in pain, the diagnosis is confirmed.
  

Treatment

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) such as ibuprophen, Naproxyn
• Muscle relaxants and narcotic pain relievers might be prescribed for more severe pain.
• Physical therapy
• Exercise program to improve flexibility and increase pain free movement
• Posture correction
• Activity Modification to avoid excessive lifting, stretching, bending
  

Approximately 80% of the patients who follow an active rehabilitation program and take NSAIDs become pain free. This usually lasts several months.

When conservative treatment fails, a surgical procedure called, Raiofrequency Rhizotomy, uses an electrical current to destroy the sensory nerves to the joint, resulting in pain relief.

(Brought to you by Jupiter Spinal Decompression)

Discitis and Back Pain

Discitis is relatively uncommon but it usually affects children under the age of ten. It is a low grade infection, usually caused by staphylococcus or a virus. It affects the disc space between two vertebrae and develops very slowly. Medical experts say this should be viewed in the same category as vertebral oseomyelitis (infection within the vertebrae). It can lead to severe, debilitating, neurological damage.

Disease Process

The infection does not start primarily in the in disc space but migrates there from other sources in the body. Urinary tract infections, pneumonia, and soft tissue infections are believed to be the most common sources. Often, no site of infection is discovered. The lumbar (lower) back is affected most often, followed by the cervical spine (neck) and last is the thoracic spine (upper back). Some post-surgical patients have developed the disease weeks after their operation, and, in their case disease diagnosis is not delayed. They rarely develop neurological deficits.

The edges of the disc erode and the degree depends upon the amount of infection and destruction within the disc. These areas become calcified, once healing begins, and, eventually, there is an interbody fusion, when healing is completed

Disease in Adults

This infection has a slow, insidious onset which can result in diagnosis being delayed for months. Pain in the back and neck are the most common complaints and movement makes it worse. Because the symptoms are similar to those of back strain, there is usually a delay in seeking medical attention. A doctor is often not seen until the sufferer develops an elevated temperature and chills, with weight loss. This delay can lead to a severe condition and the mortality rate (death rate) ranges between 2% to 12%. It more commonly affects males, with a ratio of 2:1 that has gone as high as 5:1.

Disease in Children

The onset is often more sudden, acute, and the back pain is accompanied by a refusal to walk, sit up, and there is extreme irritability. There may be localized tenderness over the spine and decreased range of motion.

Common Symptoms in Adults And Children

• Elevated temperature
• Chills
• Sweating
• Feeling of fatigue
• Loss of appetite
• Localized tenderness of spine
• Pain may travel to other parts of the body, including abdomen, hip, leg, groin.
• Movement aggravates pain.

Diagnosis

• Laboratory studies
• Sputum cultures may be done to isolate bacteria for diagnosis.
• Blood Culture
• X-rays of spine may show narrowing of disc space.
• Nuclear scan of spine
• CT Scan (Computerized Tomography)
• MRI (Magnetic Resonance Imaging)
• Echocardiogram can identify bacterial endocarditis which is responsible for some cases of discitis.
• Needle Biopsy of painful area to obtain tissue for culture

Treatment

• Antibiotics specific to kill organism once it’s identified
• IVs for hydration and supportive care
• Immobilization is necessary.
• Usually 2 weeks of bedrest
• Back brace when patient is able to ambulate
• This allows vertebrae to fuse in an aligned position.
• Bracing may be necessary for 3 to 6 months following treatment to avoid collapse of vertebrae and development of kyphosis ( curvature of spine – ‘round back’)

Discitis occurrence in the US ranges from 1 in 100,000 to 1 in 250,000 but in less developed countries, it is more common. In some parts of Africa, 11% of all patients seen for back pain were diagnosed with discitis.

(Brought to you by Lake Worth Chiropractor)