Lumbar and Cervical Facets: Facet Syndrome

According to an article in The Journal of Joint & Bone Surgery, “Facet joints are implicated as a major source of neck and low-back pain. Both cervical and lumbar facet syndromes have been described in the medical literature.” In fact, in a 1933 article in Journal of the American Medical Association, Ralph K. Ghormley, M.D. created the term facet syndrome to designate a constellation of symptoms linked to degenerative changes of the lumbar spine.

Facet joints are small, stabilizing joints that occur on each side of the spine as one spinal vertebra meets another.  Facets are found at every spinal level, save the top one, and at each level, the angle of the facet can be different which accounts for the different motions of the spine.

Facet joints allow for balancing motion with stability in the spine.  They preserve roughly 20% of torsional, or twisting, stability in the neck and low back. According to SpineHealth, “The vertebrae of the chest area are normally far less mobile and permit a small amount of forward or backward and some side bending, and very little twisting. In the low back, forward-backward bending is limited to about 12 degrees and lateral (to the side) bending to about 5 degrees. Lower back rotation is limited to only about 2 degrees per segment, since excessive rotation could lead to spinal cord or nerve damage.”

Because facet joints are meant to ensure stability, excessive use including rotation, extension or flexion, of the spine can create degeneration of joint cartilage and changes in other spine elements, like intervertebral discs. When discs lessen in heights with natural aging, the mechanical loads of the facet joints increase, leading to additional degeneration. Ligaments envelope the facet joints and with disc height shrinking, these ligaments can bulge and irritate the nearby nerve roots.  It is a circular problem.

Cervical facet syndrome includes following symptoms:

  • Pain that does not radiate past the shoulders
  • Limitation of extension and rotation movement
  • Localized radiating pain or such pain in the shoulders and upper back

Lumbar facet syndrome is characterized by symptoms, including:

  • Lower back pain and tenderness
  • Tenderness or stiffness of the spine in the lower back
  • Difficulty with movements that involve engaging the lower back
  • Pain when hyperextending
  • Pain that extends from the flank, hip, and upper thigh (pain main penetrate deeply here)