Diagnosing and Treating Facet Syndrome

Getting an accurate diagnosis for facet syndrome requires an individual to go to a major medical center with an experienced team of spine specialists. A skilled team is necessary for proper diagnosis and treatment since facet syndrome pain can mimic other conditions, such as sciatica from a herniated disc, arthritis in the hip, and other trauma that causes lower back pain.

A diagnosis of what is leading to the stiffness, weakness, pain, or other symptoms starts with a doctor getting a complete medical history, including finding out about any injuries a person may have had, along with asking for details about the site(s) and severity of the pain and the duration and onset of the symptoms, as well as how it impacts sleeping, walking, and/or sitting. During the exam, a doctor may ask an individual to move into positions that cause discomfort and to point to where the pain is felt. The doctor will likely feel for tenderness over the spine. Basic neurological tests are often performed to locate any weakness in the muscles.

Further tests may be completed to search for medical issues that cause similar symptoms and to confirm the diagnosis of facet syndrome.

One diagnostic test that may also treat the symptoms of facet syndrome is an injection into the facet joint (described below).

Tests that are offered at Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care include:

• Computerized tomography (CT) is a noninvasive procedure that uses X-rays to produce a three-dimensional image of the spine. A CT reveals more details, such as bony anatomy, than an X-ray.
• Electromyography and nerve conduction studies (EMG/NCS) may be used to measure the electrical activity in the nerves and muscles. It can be used to identify nerve damage or nerve compression.
• Injection into the facet joint with an analgesic, sometimes along with cortisone (a steroid to reduce inflammation), may be included as a diagnostic test and may also treat symptoms. Fluoroscopic guidance ensures accurate needle placement in the facet joint. If pain decreases after the injection, it may confirm the facet joint as the source of the pain. If the injection brings no relief, it may mean that facet joint syndrome is not the predominant cause.
• Magnetic resonance imaging (MRI) uses magnetic fields and radio-frequency waves to create an image of the spine that reveals the discs, nerves, spinal canal, and other details that can’t normally be seen on an X-ray. Sometimes an injection of a contrast agent is used to highlight certain tissues and structures to make details even clearer. An MRI can also reveal previous injuries.
• A myelogram uses a dye that is injected directly into the spinal column and is done in conjunction with an X-ray or CT scan. It can be used to identify a herniated disc.
• X-rays can usually reveal broken bones or injured vertebrae but cannot show soft-tissue problems, such as bulging discs, or issues with muscles or ligaments.
• Once a diagnosis has been confirmed at Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care, a person with facet syndrome will receive an individualized treatment plan from our team of specialists.

Treatment Options
Treatment for the symptoms of facet syndrome should be conservative at first before surgery is considered. Facet syndrome pain may get better on its own with time, self-care, and home remedies such as:

• Hot or cold compresses
• Over-the-counter pain medication such as ibuprofen and acetaminophen
• Pain medication
• Reduced activity and rest
• Specific back exercises and/or stretching routines

Medical Therapy: In cases where there is structural damage to the spine, the following medical therapies can help:

• Alternative treatment like acupuncture and massage
• Bracing to stabilize the spine and reduce pain
• Joint injections of a steroid to reduce inflammation
• Muscle relaxants
• Oral steroids
• Physical therapy to strengthen the core muscles surrounding the spine and to teach pain-free ways of moving
• Prescription medications for pain, including non-steroidal anti-inflammatory medications (NSAIDs) and opioids if necessary

Discomfort from facet syndrome responds well to the conservative therapies mentioned. It is important to realize that an individual with facet syndrome needs to avoid activities that cause pain. This may be a challenge for athletes who are anxious to return to their sport, but it is important to let inflammation in the joint subside. Similarly, even if an individual is feeling better, a prescribed course of anti-inflammatory medications should be completed.

Also, a doctor or physical therapist may prescribe regular stretching and strengthening exercises that need to be followed for months or become part of a lifelong habit. These exercises, along with cardiovascular activities, may reduce stress, lower inflammation, and improve overall health.

In some cases, surgery may be required to relieve the pain of facet syndrome.