Cervical Facet Syndrome

Anatomy

Facet joints are present in the rear, or posterior, portion of the cervical spine between the second through the seventh cervical vertebrae.  In the majority of this region, each vertebra is composed of a cylindrical anterior, or front, portion and a posterior bony archway that join to form the spinal canal.  The archways at each level rest upon one another at the facet joints.  These joints are cartilage-lined and are surrounded by a lubricating capsule.  Facet joints help to stabilize the spine, while permitting controlled motion of the neck.

The Problem

Facet joints can deteriorate over time.  They may become damaged through injury, general wear and tear, or due to changes in mechanical loading occurring when discs deteriorate.  Cervical facet joints are particularly prone to damage by whiplash injury. 

Facet joints are subject to the aging process, just like other cartilage-lined joints in the body.  Cartilage begins to wear away over time, leading to stiffness and inflammation.  When accompanied by degenerative changes in the discs, abnormal motion and bone on bone contact can occur in the facet joints.  This can produce pain or limited motion.  Bone spurs begin to form at the edges of the affected joints.

These changes can give rise to pain.  Cervical facet join pain may result in headache or may involve pain in the neck, shoulder or upper to mid-back.  The distribution of pain symptoms is largely determined by the level of the cervical facet joints affected.

Diagnosis

Cervical facet syndrome cannot be diagnosed on the basis of spinal images or specific physical examination findings.  Pain with stress on the joints, typically combined neck extension and rotation, suggests the diagnosis. 

Using the fluoroscope for guidance, a small amount of local anesthetic can be injected around the small nerve branch that supplies the facet joints at the suspected level of involvement. This procedure, called a diagnostic medial branch block, temporarily numbs the facet joint.  Good short-term pain relief of pain helps to confirm that pain is coming from the facet joints that have been blocked.

Treatment

Treatment may include temporary rest, avoidance of painful positions and heat, ice or the use of anti-inflammatory medications.  Physical therapy can be useful in delivering pain-relieving modalities and restoring range of motion.  Longer term goals focus on restoring function and the limitation of pain flares through a progressive exercise regimen that includes strengthening and stabilization of the neck.

If anesthetic blocks confirm that pain is coming from the facet joints, a local heating procedure of the medial branch can be performed using a needle under fluoroscopic guidance.  This procedure, known as radiofrequency ablation, can provide pain relief that lasts 6-12 months at a time.