Lumbar Facet Joint Syndrome

Physician evaluating patient's back pain.

Each vertebra or bone in your spine has two sets of facet joints, an upper and a lower facet joint. The superior or upper facet allows movement with the vertebra above, and the inferior or lower facet allows movement with the vertebra below. For example, most people have 5 lumbar vertebrae in their low back, and at L4 (the 4th lumbar vertebra), there are 2 facet joints: the L3/4 is the joint between L3 and L4, and the L4/5 is the joint between L4 and L5. Each of the joints, like other joints in your body, has a capsule or covering called a synovial membrane, cartilage on the surface of the joint to allow smooth movement and fluid in the joint called synovial fluid which lubricates the joint. The facet joints, also called Zygapophyseal or Apophyseal joints (or Z-joints), allow you to move your spine forward (flexion) or to bend backward (extend). Facet joints protect against shearing forces of excessive range of motion. Osteoarthritis, Degeneration, Instability, Spondylolisthesis (shifting), dislocation, fracture, injury and surgery may all disrupt the normal function of the joint and cause pain. Like all joints, as we age and perform activities, the facet joints may degenerate and become irregular. These age related changes are called Degenerative Joint Disease or degenerative arthritis of the facet joints and are one of the most common causes of mechanical low back pain. This condition is also called Facet Disease, Facet Syndrome, Facet Arthropathy or Lumbar Spondylosis. Patients will typically complain of pain at or above their waist that does not radiate into their legs (or that radiates above the knee). The pain is typically worse with extension or bending back of the spine, and improved with flexion of the spine. Many times, the pain will worsen with weather changes and be very severe in the morning on awakening. The pain may be sharp or dull. Sometimes, if the facets enlarge with fluid or spurs, the facets may cause referred pain into the legs. Facet Disease can often be seen on imaging such as MRI, CT scans, or X-rays and can also be suspected after a physical exam done by your provider. However, the diagnosis of facet disease is confirmed by facet blocks or medial branch blocks. Medial branch blocks may be another alternate to epidural steroid injections. Epidural steroid injections are not always helpful for the treatment of low back pain. Patients may describe transient or minimal relief with a block or block series.