Lumbar and Cervical Facet Syndrome
The lumbar facet joint have long been considered to be a significant source of low backache. The prevalence of cervical pain approaches that of lumbar spine pain and recently the cervical facet joint has been shown to be a significant source of chronic neck pain. The thoracic facet joints are less firmly established as cause of back pain.
The facet joints are paired synovial joints one on each side formed by the inferior articular process of one vertebra and the superior articular process of subjacent vertebra. The sensory nerve supply of facet joints is from Medial branch of posterior ramus, which supplies the lower pole of the facet joint at its own level and upper pole of facet joint below.
The facet syndrome can arise due to chronic inflammation of the joints, arthritis, secondary to disc degeneration and trauma. In about 50-60 % of Post Whiplash neck pain patients, cervical facet joints are the primary source of pain.
While the lumbar facet syndrome usually presents as low backache which can be referred to the buttock, groin, hip, posterior and lateral thigh but only occasionally below the knee, Cervical facet syndrome causes referred pain in the neck & shoulder region, headaches (Cervicogenic headaches) and upper back region.
In the absence of any radiologic investigation standard for identifying painful facet joint, the gold standard for making a diagnosis is the abolition of facet joint pain by either injection into the joint or blocking the two Medial branch nerves supplying a joint. It is recommended to undergo local anaesthetic block twice once with a short acting and then with a long acting local anaesthetic before proceeding for Radio frequency lesioning of Medial branch, which is the only validated treatment for lumbar facet syndrome.