Cervical facet syndrome describes a condition where degeneration of the spinal zygapophyseal joints is deemed to be a pathological health issue and the direct cause of neck pain. Facet joint syndrome can be considered a mechanical or neurological pain syndrome, depending on specific factors involved in the particular demonstration of the condition. The cervical facet joints suffer deterioration as a normal part of their lifecycle. In fact, most people will begin to show evidence of spinal aging in the facet joints during their 30s or 40s, with some people demonstrating facet arthrosis even earlier in life.
This discussion takes a detailed look at facet joint pain in the cervical spine. We will provide background information that proves the universal nature of facet degeneration and explain why, in some people, pain is theorized to be caused by this completely normal part of the aging process.
Cervical Facet Syndrome Defined
Facet joint syndrome is a diagnosis that implicates the spinal zygapophyseal joints as the cause of acute or chronic pain in the neck. The facet joints are important structures that help to link the vertebral bones together into a contiguous backbone and also help facilitate movement of each vertebral bone in multiple directions.
The facet joints are located on the far posterior side of the vertebral bones and are located just to each side of the large spinous processes that are able to be visualized through the skin on a rear view of the anatomy. There are left and right facet joints at each vertebral level, helping to stabilize the vertebrae bilaterally.
Facet syndrome is diagnosed when these joints deteriorate and are thought to cause pain through one of 2 possible mechanisms:
The neurological mechanism of symptoms describes pain that occurs when tiny nerves become pinched inside a hypertrophic facet joint. Alternately, or additionally, the facet joints can become inflamed as to compress exiting nerve roots within the neuroforaminal spaces.
The mechanical theory of pain occurs when arthritic surfaces of the facet joints rub violently together, breaking down the remaining protective measures that typically insulate a healthy joint. This process results in the growth of bony outcroppings of skeletal tissue, called osteophytes. When osteophytes prevent proper motion of the joint, much in the way a speed bump impedes a car’s movement, pain and limited range of motion can result.
Cervical Facet Syndrome Symptoms
Facet syndrome is a hotly-debated and controversial diagnosis that is not embraced universally by all care providers. Many doctors, chiropractors and therapists disagree that most diagnosed cases involve any pathological process, but instead consist of normal age-related changes seen throughout the body that have never been proven to cause pain to any significant degree. Other care providers embrace the diagnosis of facet syndrome, fully adhering to the Cartesian philosophy that if anatomical structure is considered to be even slightly abnormal, pain will likely result.
We at The Cure Back Pain Network take an objective, middle ground stance on this argument, since we fully agree that most cases of facet joint deterioration are indeed benign and non-symptomatic. Research evidence from countless studies supports this fact. There is little proof that normal facet joint aging is the cause of any pain or functional impairment at all. However, we have also seen instances of grossly exaggerated facet degeneration that is pathological. This is particularly true for cases of mechanical pain that are obvious and limiting in normal range of joint motion.
In mechanical symptomology versions of facet syndrome, pain is usually elicited locally during a highly specific set of movement of the affected vertebrae. This pain might feel like a grinding of bone surfaces or the inability to move the region fully, due to interactions between the rough surfaces of the osteophyte-laden joints.
Neurological versions of facet syndrome are more controversial and the symptoms often range far beyond clinical expectations, casting additional doubt on the accuracy of the diagnostic theory. Patients often have pain in relatively large regions of the back or neck, yet only demonstrate facet syndrome at one or two levels. Since the nerves implicated as being compressed are tiny, the symptomatic expression seems unfounded from a structural point of view.
In neurological cases where the symptoms are deemed to be caused by neuroforaminal stenosis due to hypertrophic facet joints, the symptoms should be expressed in the destination anatomical location for the affected nerves, which usually means the shoulders, arms or hands. Pain might be part of the initial symptom set, but should progress to paresthesia, numbness and eventual weakness, if the nerve is truly compressed within the foraminal opening.
When symptoms do not match the diagnosis by location, span to far from the actual joints or do not follow the clinical expectations for expression, there is certainly reason to doubt the diagnosis and continue to look for evidence of an alternate explanation for pain. Remember, in most cases of facet joint arthritis, the structural changes are innocent of causing any harm or pain, even though these alterations are clearly visible on diagnostic imaging studies.
Cervical Facet Syndrome Treatment Options
Most instances of mild to moderate facet arthrosis do not require treatment, since these cases are not symptom-generating. For cases that are outside of the norm and do cause pain, treatment varies considerably, depending on the presentation, exact nature of the deterioration, extent of the symptoms and type of care provider consulted.
Conservative care might consist of physical therapy, chiropractic, massage, acupuncture or pharmaceutical treatment. None of these care methods will typically act on resolving the causative process in the spine, if the facet deterioration is indeed pathological. Physical therapy and chiropractic might minimally help the resolve mechanical joint problems, by accelerating the breakdown of osteophytes, eventually allowing more comfortable joint movement if the offending spur is decreased in presence. However, there is equal chance that continued movement of these joints might have the opposite effect, increasing the size of the spurring and further decreasing joint mobility and the increasing the generation of localized discomfort.
Surgical care for facet joint syndrome involves several options. Minimally invasive practices include facet joint injections, usually consisting of steroids, anesthetics and flushing solutions. Other minimally invasive techniques include various types of nerve ablation practices, such as facet rhizotomy, utilizing radiowaves, diathermy and other procedural options. These are most often used for neurological versions of facet syndrome. More invasive surgical fixes include specific versions of laminectomy and foraminotomy, as well as targeted removal of large spurs from within the facet joints themselves, often utilizing laser technology.
Research statistics show that most patients who receive treatment for facet syndrome do not require it, since they only demonstrate typical versions of arthritic deterioration that is not likely to be the actual cause of pain. This helps explain the inefficacy of many therapy options.
When the diagnosis is sure and sound, conservative care is not the best path, since it will not likely ever resolve the underlying anatomical problem within the joint. In these cases, minimally invasive surgical techniques are generally relatively safe and effective for ending pain and restoring normal range of spinal joint movement. Just be aware that these types of surgical endeavors do have risks and occasionally require the worst damaged vertebrae to be reinforced using some variety of fixation hardware or spinal fusion.