Facet syndrome includes degenerative changes and is associated with muscle spasms, which develop when facet joint is involved in forceful sprain or violent twisting motion. Facet joints are located throughout the spine including neck and lower back. It is also called apophyseal joints
Facet syndrome may be in the cervical (neck) thoracic or lumbar spine (lower back). It is caused by sudden stop of vehicle resulting in whiplash injury, athletic or occupational injury, and sudden jerk of the neck that result in overriding the superior and inferior articular facet joints.
Chronic degenerative changes include capsular hypertrophy, bony spur formation, and increased fibrous layer formation. All above contribute to stiffness, limited range of movement of the neck, muscle spasm, or pain. Rotating motion and hyperextension may aggravate the pain. Pain is usually dull, aching, nagging in character, and radiates to back of head and shoulders.
Cervical facet syndrome is diagnosed by evaluating a patient’s history, physical exam, and X-ray test. Patient usually has localized tenderness in paraspinal muscles in the neck. Range of motion is limited due to muscle spasm. In some cases, patient may need diagnostic facet injection to pinpoint the diagnosis. Patient usually undergoes diagnostic injection in the joint or Paravertebral nerves that supply the joint. If the patient has good pain relief following the injection, it is suggested the pain is originating from the facet joints. In that scenario, patient may benefit from facet joint rhizotomy where small nerves are disconnected with radio-frequency thermo coagulation needles with out any incision involvement.
Conservative treatment includes local heat, NSAIDS and local myofacial massage. Trigger point injection may alleviate the spasm. In selective cases, patient will need diagnostic and therapeutic facet injection under fluoroscopy.