Dr Ozello’s Sports Medicine Report: Lumbar Facet Syndrome
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Lumbar Facet Syndrome
Low back pain is one of the most common musculoskeletal complaints encountered in clinical practice.
Facet Joints (AKA Zygapophyseal Joints or Z-Joints)
The lumbar facets are composed of the inferior articular process of the vertebra above and the superior articular process of the vertebra below.
The zygapophyseal joints serve to stabilize the spine and prevent injury by limiting the spinal range of motion.
The facet joints are true synovial joints.
The lumbar facets are prone to degeneration over time and can cause chronic low back pain when irritated. Contains cartilage on each surface.
Surrounded by a capsule of connective tissue.
In combination with disc, facet joints create a three joint complex at each vertebral motion segment.
Superior Articular Process & Inferior Articular Process: Branch off arch superiorly and inferiorly between pedicle and lamina.
Pars Interarticularis (Pars): Bony bridge between superior articular facet & inferior articular facet.
Greater workload when spine is extended.
Symptoms can be acute or chronic.
Chronic: Usually has insidious onset.
Deep, dull, achy pain.
May be unilateral or bilateral.
Point tenderness.
Muscle hypertonicity and muscle guarding.
May radiate into bilateral glutes and proximal hamstrings.
Aggravated by lumbar extension.
Aggravated by standing.
Pain increases with lumbar hyperextension, extension–rotation and straightening from flexion.
Localized unilateral back pain, pain with palpation of facet joint and pain relieved by flexion.
Lumbosacral facet syndrome can occur secondary to repetitive overuse and microtrauma, spinal strains and torsional forces, poor body mechanics, obesity, and intervertebral disk degeneration over the years.
References
Osteoarthritis of the spine: the facet joints
Sacroiliac Joint Pain
Lumbosacral Facet Syndrome
Facet Joints AKA Zygapophyseal Joints or Apophyseal Joints
The function of facet joints is to allow for flexion and extension of the spine while limiting rotation and preventing the vertebrae from slipping over each other.
Facet joints form from the superior and inferior articular processes of two adjacent vertebrae.
Bilateral and situated between the pedicle and lamina.
The facet joint is a true synovial joint, containing a synovial membrane, hyaline cartilage surfaces, and are surrounded by a fibrous joint capsule.
The joint also contains synovial fluid which is kept in place by an inner membrane.
The sensory innervation of the facet is supplied by the medial branch of the posterior rami of the spinal nerve at the level of, and the level above, the facet joint. For example, The L3-L4 medial branch receives innervation from the L2 and L3 medial branch nerves.
The facet joint is formed via the posterolateral articulation connecting the inferior articular process of a vertebra with the superior articular process of the vertebra directly inferior. The facet joint is a true synovial joint, containing a synovial membrane, hyaline cartilage surfaces, and surrounded by a fibrous joint capsule.
The orientation of the facet joints varies by location within the spine, which relates to the principal planes of motion allowed at each spinal level.
In the lumbar region, the facet joints are inclined to a nearly vertical orientation, and are curvilinear, a shape that highlights their role in preventing rotation as well as forward displacement.
Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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