Facet Joint Syndrome

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 29 December, 2010


Joint is the meeting point of two or more bones. The joint allows the movement of bones. The bones of the spine are called vertebrae. Vertebrae are interconnected through facet joints, else known as zygoapophyseal joints or apophyseal joints.

Every vertebra has two pairs of facet joints. The two processes (apophyses) sticking out of each end of a vertebrum connecting it with the upper vertebrum are called “superior articular processes”, while the two processes sticking out of each end of a vertebrum connecting it with the lower vertebrum are called ‘inferior articular processes”.
They are located at the posterior part of vertebrae.

The facet joints have a synovial bursa and the facets are covered with cartillaginous tissue so that they are smooth and can move without any friction.
Facet joints allow for flexion, extension and rotation of the spine by keeping it stable.
Each joint is innervated by two nerve rami which branch out into the posterior lumbar nerve trunks. These branches course along the groove that is formed where the superior articular processes merge with the transverse processes.


Facet joints are responsible for  pain in 15-45% of patients with chronic low back pain. (14-17)  The disorder is more frequent in advanced ages and may be due to degeneration, strain and inflammation. (18,19) Radiological examinations very often show osteoarthritis findings and general facet joint degeneration, both in asymptomatic patients and symptomatic patients, and are not diagnostic modalities.

Patients with low back pain due to facet joints complain about low back pain centrally or maybe slightly paravertebrally, not clearly located, which may radiate to buttocks and posterior thighs down to the knees.  When the superior articular processes are affected, the pain may radiate to the hips and lateral thighs down to the knees. Very rarely does the pain radiate below knees. The pain is aggravated at the standing and sitting position, and is relieved when lying down. When getting up in the morning, the patient usually feels stiff and in pain.

During the physical examination, patients report pain when pressure is exerted paravertebrally and  during the extension and rotation of the spine, while the pain is relieved at spinal flexion. Should there not be any other pathology, the neurological examination is normal.


The clinical examination and radiological evaluation provide some information but are not sufficient to set the diagnosis of the painful facet joint syndrome.
The diagnosis is set by blocking the nerve branches that innervate the suspicious joints with the use of local anesthetics. As long as the patient reports more than 50% pain relief during the anesthetic action and becomes able to carry out activities which he could not before, then and only then is set the diagnosis of the facet joint syndrome. (54,55,57,58,59)


The conservative treatment includes non-steroid anti-inflammatory drugs, paracetamole and physiotherapy/ kinesiotherapy. Should the pain persist after 6 weeks of conservative treatment, then the treatment of choice is the radiofrequency facet joint denervation using a  needle-electrode on  the nerve branches that innervate the painful joints. (75-82)

The technique is applied with percutaneous local anesthesia and under radiological guidance. It is absolutely safe when conducted by a skilled Interventional Pain Physician (IPP) and the result lasts 9-24 months. Should the nerves regenerate but pain recurs, the therapy can be repeated as many times as necessary. The treatment is scientifically evidence-based and is strongly recommended by the international scientific community.


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