Orthopedics-Online

Facet syndrome of the lumbar spine

What is Lumbar Facet Syndrome?

Facet syndrome is an irritation of the small joints in the spine, the so-called facet joints. The reason for this irritation is usually a pre-existing osteoarthritis of these joints. The facet syndrome can in principle occur at any point on the spine. The spine is divided into three sections: the cervical spine (cervical spine), the thoracic spine (thoracic spine) and the lumbar spine (lumbar spine). Facet syndrome occurs most frequently in the lumbar spine, the second most common in the cervical spine.

causes

The pain syndrome ultimately arises from signs of wear and tear on the spine and its complications. This clinical picture is called osteoarthritis. Because the lumbar spine is at a low level, it has to bear the greatest strain in the long term, since it has to support the entire weight of the body above this point. Consequently, signs of wear and tear are often the first noticeable here.

Usually there are several factors that ultimately lead to a facet syndrome of the lumbar spine on the basis of existing osteoarthritis of the small intervertebral joints.

This includes, above all, the long-term overload of the lumbar spine (lumbar spine). They are often found in people who often have to bend down and straighten up in their job or in their everyday life, or in those who have to lift and carry heavy loads. People who are overweight are also more likely to suffer from lumbar facet syndrome, as their lumbar spine has to bear an even higher load than people of normal weight.

You can find more here Symptoms of osteoarthritis

You can recognize lumbar facet syndrome by these symptoms

This clinical picture, also known as lumbar facet syndrome, is particularly impressive due to pain in the lumbar area. Those affected complain of so-called "lower back pain". It can happen that the pain radiates into the thighs, less often into the buttocks or the groin region. The symptoms usually worsen during the day and also when the facet joints are stressed, for example when you go into the hollow back or walk or stand for a long period of time; however, they improve when lying down. In addition, the spine can become stiff, which limits mobility.

Pain in lumbar facet syndrome

The pain in lumbar facet syndrome is localized in the lower back. Since nerves of the spinal cord emerge near the damaged structure, the pain can radiate. The buttocks, thighs or the groin area can be affected. The referred pain can result from direct entrapment of the nerve root or from an inflammatory reaction that spreads in this area. Depending on which structure is affected, the pain radiates into different regions.

As mentioned above, the pain that is triggered by facet syndrome is pain that increases with exertion. As a result, the pain is more intense at the end of the day and increases with increasing stress. Standing or sitting for long periods of time puts particularly intense strain on the lumbar spine and is often associated with pain in this area.

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Can lumbar facet syndrome cause groin pain as well?

Lumbar facet syndrome can also lead to groin pain. This is due to the fact that nerves emerge from the spinal cord in the area of the facet joints. These move from there to the periphery. If the facet joint is inflamed due to pre-existing osteoarthritis, this can lead to nerves being pinched or the inflammation radiating to the nerves. From the lumbar spine area, nerves pull into the buttocks, legs, genital region and also to the groin.

diagnosis

To diagnose a facet syndrome, the doctor should first characterize the pain in more detail. For example, the presence of a facet syndrome is indicated by the fact that the pain increases with the formation of a hollow back and that it progresses with increasing stress. Applying pressure to the facet joints in the prone position also causes pain. The occurrence of pain when bending to the side or rotating, for example when turning over in bed, suggests damage to the facet joints.

In the next step, an x-ray of the lumbar spine can be made. Arthrosis of the facet joints can be recognized there.

A test infiltration of the facet joints can also be performed. An anesthetic is applied to the joint. If this leads to an improvement in the symptoms, this indicates the presence of a facet syndrome.

therapy

Symptomatic therapy aims to relieve pain. Painkillers, physiotherapy, massages, or the facet joint infiltration mentioned above can all reduce pain. Wearing a corset can relieve the face on the lumbar spine for a short time, which can also lead to a reduction in pain.

However, the aim of treatment should be to remedy the underlying disease. Weight reduction if you are overweight is a high priority. The back muscles should be strengthened through physical activity so that they can stabilize the spine.

Exercises

Physiotherapeutic exercises of the core muscles can build up and strengthen the muscles. This relieves the load on the bony spine, which leads to a reduction in pain.

You can find specific exercises for the lumbar spine here: Exercises for existing facet arthrosis

Desolation

If the above-mentioned measures cannot be implemented and the pain is at a very high level, the nerve, which lies on the affected facet joint and which causes the pain through inflammation-related irritation, can be separated or "obliterated" by means of an operative procedure. This can be done through thermal coagulation or radio frequency ablation. This is a method for the local destruction of tissue by means of heat generated by electromagnetic waves. The joint is accessed percutaneously, i.e. through the skin.

Duration

The duration of the persistence of a facet syndrome cannot be determined across the board. The disease is an expression of wear-related damage to the joints. This wear and tear cannot be reversed. If no measures are taken to strengthen the muscles and thus relieve the lumbar spine, no improvement in symptoms is to be expected. Building and strengthening the muscles require regular training over several weeks. Weight loss also requires persistence and a change in lifestyle. If these measures are carried out consistently, the symptoms of the facet syndrome can improve after a few weeks. Surgery to cut the affected nerve can provide timely pain relief.

forecast

The prognosis, like the duration, cannot be generalized. It depends on the damage to the joints and external circumstances. In this case, however, it is also true that those affected who seek causal and not merely symptomatic therapy have a better prognosis. Even if sclerotherapy achieves the most efficient result, this does not rule out damage to other joints and the recurrence of the symptoms. You should therefore always aim for weight reduction and strengthening of the muscles.

How can one distinguish a facet syndrome from an ISG syndrome?

The sacroiliac joint is the joint that connects the spine and pelvis. In ISG syndrome, the pain occurs in this area. Those affected often suffer from attacks of pain during certain movements such as rotating or bending. An increase in pain with increasing exertion can also occur. As with facet syndrome, the pain can radiate into the buttocks and legs, for example. Differentiating the two syndromes can therefore be difficult, as they also have their origin in the same cause and can also occur together. However, the pain is localized differently, which is noticeable, for example, through pressure pain in different areas of the spine. The doctor is also able to diagnose a blockage of the SIJ, in which the joint-forming bones have shifted against each other, during the physical examination. Another indication of SIJ syndrome can be the sudden appearance of the symptoms, as it can happen that the bones that make up the SIJ suddenly dislocate with a certain movement.

Here you will find efficient Exercises that can help with an SIJ block.