Facet Joint Syndrome

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Original Editors - Niels Cloet, Jonas Vangindertael

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Definition/Description

Lumbar facet joint syndrome is a multi-factorial process that is intimately tied to degeneration of the intervertebral discs. It’s a painful irritation of the posterior part of the lumbar spine. The swelling of the surrounded structures can cause pain and irritation of the nociceptors.

Clinically Relevant Anatomy

The capsule of the facet joint is reinforced posterioly by the multifidus muscle and anterioly by the ligamentum flavum. It is surrounded by fascia, wich itself is continuous with that covering the ligamentum flavum and the investing fascia of the vertebral body. The facet joint capsule therefore can be seen as a bridge of connective tissue between the ligaments of the neural arch and those of the vertebral body. The functions of the lumbar facet joint are flexion extension lateroratation and rotation. 

Epidemiology /Etiology

Because of an acute trauma amounting the posterior facet joints, little capsular bursts form and leads to a joint subluxation. The synovium round the joint is damaged and leads to synovitits. Secondary there will be a protective mechanism that provides a hypertonic contraction of the surrounding muscles (M. Multifidi and M. semispinales) that increase the pain. Those changes lead to fibroses and osteophyte formation. 

The most common cause is a repetitive micro trauma and chronic degradation. In daily life it can appear by a long standing of load of the lumbar spine by extension (hang out the wash, ceiling painting, etc.). Or in sports where repeated powerful hyperextension of the lumbar spine is necessary

With aging, cartilage of the facet joint can split parallel to the joint surface, pulling a portion of joint capsule with it. The split cartilage, with its attached piece of capsule, forms a false intra-articular meniscoid. Flexion normally draws the fibro adipose meniscus out from the joint, and it moves back in with extension. Fibro adipose meniscus, covered by synovium, project from the joint capsule at the superior and inferior poles and enter between the articular surfaces protect the articular cartilages in gliding joints that subluxate during normal movement.  If the meniscus fails to move back, it will buckle and remain under the capsule, causing pain.  

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