Before we can understand what a facet syndrome is we need understand a little lumbar spine anatomy.
The lumbar spine consist of five separate movable bones each called a lumbar vertebra and are numbered one through five as you move from top to bottom. The last lumbar vertebrae, typically the fifth lumbar, is positioned above the sacrum.
Each vertebra is divided into a front called the body and the back known as the posterior vertebral arch. The body of the vertebra is connected to each adjacent vertebra by a disc. The fifth lumbar vertebra is joined with the sacrum by a disc as well.
The posterior vertebral arch possesses four joint surfaces known as facets. There are two on each side, a superior and inferior facet. The superior facets along with the inferior facets of the vertebra above makes up a joint. Therefore, each vertebra consists of four posterior joints, a right superior and inferior joint and a left superior and inferior joint.
Separately these joints allow for slight movement but together permit the gross movement of our low back which allows us to bend, twist and tilt side to side.
Each of these joints is heavily endowed with nerve endings some of which convey the messages of pain.
When you observe the lumbar spine from the side view, or lateral view, you will notice it has a curve to it known as lordosis. This curve is concave in the back and convex in the front.
It is the shape of the lumbar bodies that determines, for the most part, what should be our normal lumbar curvature or lordosis. This lordosis can be reduced too much causing what is known as hypo-lordosis or " flat back". Or, the curvature may be exaggerated or too extreme causing what is known as hyper-lordosis.
When there exists a hyper-lordosis this will predispose you to facet syndrome.
A facet syndrome is a combination of signs and symptoms that arise from irritation of the facet joints. Because these facet surfaces possess pain nerves any disruption in its surface, alignment and surrounding tissue can produce pain.
Pain arises from inflammation as a result of injury to your body. Therefore, when you have pain arising from a facet there has to have been some trauma inflicted to the facets and its associated tissues. This could be the joint cartilage, ligaments, blood vessels or muscles. As with any inflammation you will find pain, heat, redness and swelling.
The major precipitating cause is usually an excessive gliding together of the facet surfaces due to degenerative disc disease, a hyper-lordosis of the lumbar spine that occurs from it being forced to bend backwards or hyper-extend excessively due to poor posture, excess weight or perhaps wearing shoes with an elevated heel.
Other causes or contributing factors are
poor sleeping positions, osteoarthritis and degenerative disc disease to
name a few.
It is these associated contributing factors that may actually be..."the straw that broke the camels back".
A facet syndrome often has an acute onset. However, it has been in the making or developing for several years. You may notice it suddenly due to a major or minor trauma or the symptoms may occur gradually over time.
Unless there is early disc degeneration, trauma, obesity or pregnancy, this lower back condition is uncommon in individuals younger than 40 years of age. All of these can place the lumbar spine into hyper-lordosis.
As stated earlier the number one cause is disc degeneration. Disc degeneration usually does not present itself before the age of 40 therefore lower back pain condition is rare before this age.
Treatment consisting of anti-inflammation drugs, nerve blocks or facet joint injections, pain relievers or chiropractic adjustments without addressing and correcting all contributing and causative factors will result in short-term relief, progressive degenerative osteoarthrosis and chronic low back pain.