pathology: facet syndrome

yogabook / pathologie / facet syndrome

facet syndrome / facet joint syndrome / arthrosis of the vertebral joint

Definition of

Sign of wear and tear of the facet joints, usually used synonymously with vertebral jointarthrosis. In a broader sense, however, facet synd rome means any painful, often pseudo-radicular disorder of a facet joint caused by a mostly chronic irritation. Facet syndrome was discovered as early as 1911 and is a common cause of back pain; it usually occurs in the lumbar region, which is also due to the fact that the extensibility and the load acting on it is considerably greater than in the thoracic spine. Facet syndromes are also found in the cervical spine, particularly after whiplash injuries. The intact facet joint nervesthat transmit the pain are lateral branches of the respective nerve root, which is why a pseudo-radicular radiation of pain occurs, but without the paresthetic component (sensory disturbances such as numbness, tingling, furry feeling) that is typical when a spinal nerve is compressed. The pain usually radiates less widely than that of an intervertebral disc and does not affect the entire dermatome. Due to the often initially mild, non-specific course without pseudoradicular pain, imaging is rarely indicated without at least 6-12 perstatic pains, so that facet syndrome is often only diagnosed after a delay. Since the facet joints represent one part of the articular connection between two vertebral bodies, the other part of which is the intervertebraldisc-vertebral system, damage to one often leads to damage to the other, possibly with a delay. The facet joints bear approx. 20% of the axial load of the spine and therefore have a thick layer of cartilage. Muscular and habitual factors as well as the use of the musculoskeletal system are often important factors in the development of the disorder. If consistent improvements are made in these areas, conservative therapy is often successful in terms of pain relief. Muscle development and appropriate tone are essential for this. Red flags for an immediate diagnosis are the occurrence of facet syndrome

  1. after a trauma such as a fall
  2. for known tumor diseases
  3. with new onset of paralysis
  4. with indications of an infection of the WS
  5. before the age of 30.

Cause

  1. Degeneration of the spinal structures such as osteoporosis, discopathies, also purely degenerative without disc hernias
  2. Arthritis
  3. Osteoarthritis
  4. Cyst or ganglion close to the facet joint(„facet ganglion“, „juxtafacet cyst“): is considered evidence of a facet syndrome
  5. Spinal canal stenosis
  6. Vertebral blockages
  7. Instability of the facet joint
  8. Muscle contractures, reflexive muscle tension
  9. Tumors
  10. Congenital malformations
  11. Postural anomalies and disorders such as scoliosis, hollow back

Predisposing

  1. Age

Diagnosis

  1. X-ray in 2 planes for rough orientation, MRI or CT to confirm the wear and exclude important differential diagnostic events, e.g. a disc hernia
  2. Diagnostic facet block with local anesthetic of the dorsal ramus of the spinal nerve under imaging control

Symptoms

  1. Without pseudoradicular pain, initially difficult to distinguish from other back pain and often prone to spontaneous remission
  2. Pain, usually dull and difficult to localize, unilateral or bilateral, sometimes stabbing or drilling.
  3. In the case of lumbar facet syndrome, possibly also hip pain or pain radiating into the leg
  4. Strain on the spine and especially extension, but also lateral flexion and, to a lesser extent, rotation of the spine worsens
  5. Improvement with forward bending of the spine(flexion)
  6. prolonged walking and standing worsens
  7. possibly morning start-up pain
  8. Repositioning pain when turning in bed
  9. Stiffness of the affected section of the spine, if applicable
  10. possibly DGS-like buttock pain
  11. Increase in pain throughout the day
  12. „Breakthrough feeling“ in the back

Complications

  1. Formation of osteophytes
  2. Formation of synovia-filled facet joint cysts due to overproduction of synovia
  3. Nerve irritation due to facet joint cysts

Therapy

  1. Anti-inflammatory drugs, analgesics, NSAIDs
  2. Back training
  3. Occupational therapy
  4. Alternating PT and protection
  5. Stretching and strengthening the back muscles
  6. Improvement of proprioception and coordination
  7. Facet infiltration of a local anesthetic with imaging control
  8. if necessary: Facet denervation (radiofrequency therapy or thermocoagulation)
  9. Cooling probes
  10. Laser therapy
  11. Acupuncture
  12. If conservative therapy fails: surgery

DD

  1. Disc hernia (herniated or bulging disc)
  2. Spinal canal stenosis
  3. Spondylolisthesis
  4. Vertebral body fracture or fracture of the sacrum
  5. Coxarthrosis (with lumbar form)
  6. Disorders of the SI joint (with lumbar form)
  7. rare: WS tumors and metastases
  8. very rare: DGS (piriformis syndrome), irritation of the lumbosacral plexus, for example due to retroperitoneal tumors

Asana practice and movement therapy

In the case of facet syndrome, it is important to try to identify causative and predisposing factors and to eliminate them as far as possible. All controllable factors in the active musculoskeletal system should be addressed. Often relief or remission can be achieved with muscular improvements. To this end, the range of postures and movements performed must be analyzed as well as muscular imbalances or other disorders. As a rule, strengthening of the autochthonous back muscles is at least one of the accompanying measures. If their tone was already increased beforehand or should be increased by the movement therapy approach, stretching them is also part of the treatment. The three movement dimensions of the autochthonous back muscles must be taken into account, i.e. the ability to flex/extend, laterally flex and rotate the spine should all be checked and brought to a usable state.

Asanas

Asanas in 601: Stretch for flexion of the sp ine
Asanas in 666: Stretch for lateral flexion of the sp ine
Asanas in 661: Stretch for rotation of the spine
Asanas in 602: Strengthening for flexion of the spine
Asanas in 667: Strengthening for lateral flexion of the spine
Asanas in 662: Strengthening for rotation of the spine