What is lumbar facet arthropathy

The facet syndrome

The facet syndrome of the lumbar spine, together with the ISG syndrome, is probably the most common specific cause of lower back pain and sciatica. If a lumbar pain / lumbar sciatica does not subside after weeks and months despite all physiotherapy, acupuncture and various general and special pain therapies, a specialist analysis is essential:

The symptom of persistent lower back pain is a widespread disease. The targeted causal therapy requires an analysis that is as individual as possible. ISG and facet joint syndromes of the vertebral joints are found more frequently in cases of genetically related weakness of the connective tissue. Early disc damage, SI joint and vertebral joint arthrosis and even rheumatic immunoreactive inflammation of fascia, SI joint and facet joints are then often associated with it.

For lower back pain caused by a lumbosacral facet syndrome of the lumbar spine, there are long-term causal therapeutic and regenerative strategies. Diagnosis, therapy and biological regenerative medicine of these specific causes of back pain are now the focus of my outpatient and inpatient specialist work.

In medicine, a syndrome is the sum of all symptoms = signs of illness due to a decompensating structure / function of the body. The facet syndrome of the lumbar spine describes the entirety of the symptoms of painfully overexcited vertebral joints = facets (joints) of the lumbar spine. In the foreground of the lumbar facet syndrome are the pain and restrictions in the hip and lower back:

In addition to genetic, often rheumatic causes of overexcited facet / lumbar vertebral joints, there are mainly

  • longer incorrect loads (sitting!)
  • acute twisting and sprains
  • Overuse related to a herniated disc or other disc changes
  • Instability of the sacrum between the pelvic blades / iliac bones due to fascia insufficiency / weak connective tissue, osteoarthritis and rheumatism

What are facet joints?

The facet joints are paired small joints on the back of the vertebral arches that encompass the spinal canal. Together with the intervertebral discs between the individual vertebral bodies, they enable segmental movements of each individual vertebra in the lumbar spine.

Like all joints, facet facet joints have a cartilage surface and a connective tissue joint capsule. The joint capsules of the lumbar vertebrae are covered by a yellowish firm connective tissue inner fascia, the ligamentum flavum (= yellow band) towards the spinal canal. Between two facet joints of the lumbar spine, the nerve roots of the sciatica pull from the body through the spinal canal to the head and from the head through the spinal canal to the body. On each nerve root there is a (very important!) Nerve source node: the nerve posterior root node = the dorsal root ganglion.

The facet joints of the lumbar spine in the lower back are about the same size as the finger joints. Due to today's (sedentary!) Way of life, together with the SI joint and the intervertebral disc, they are the most common specific cause of deep back pain. Facet irritations lead to facet arthritis and activated facet arthrosis: spondylarthritis and spondylarthrosis. Arthritis / osteoarthritis very often overstrain the dorsal root ganglion and thus lead to a whole cascade of further unpleasant painful consequential changes in the deep fasciae, the deep muscles, the intervertebral discs and the sacroiliac joints. The facet joints of the lumbar spine and the bony hip gap cannot be felt with the fingers and hands. Lumbar facets are surrounded by connective tissue / fascia and thick, often scarred back muscles, inaccessible deep beneath the often relatively thick and firm subcutaneous fatty tissue. As a rule, the backward-directed spinous process of the vertebral arch and the iliac blades as well as the superficial muscle layer of the lower back and buttocks can be palpated.

The bony parts of the facet joints and sacroiliac joints cannot be shown really well by means of X-rays due to mutual overlap in the beam path. The modern cross-sectional images from computed tomography CT, or even better today, magnetic resonance tomography MRT, are more suitable. "Tomo" means editing and "Grafie" means imaging. Joint effusions, joint capsule thickening and scarring of the surrounding deep muscles are of particular importance for a lumbar spine and SI joint specialist. Like every orthopedic surgeon with problems in other joints, the orthopedic and / or rheumatological back pain specialist must primarily recognize and assess osteoarthritis / joint wear, arthritis / joint inflammation and fibrosis / scarring of the joint capsule and deep muscles (multifidi) in the MRI.

Facet & sacroiliac syndrome with their fasciae and deep muscles must always (!) Be viewed, assessed and treated together with the intervertebral disc as a functional unit in the lower back, hips and pelvis!

Facet Syndrome in Brief

  • SIJ & facet syndrome together form the most common specific cause of the back pain symptom
  • Osteoarthritis and rheumatism of the lumbar spine and SI joint can leave permanent restrictions
  • If the lower back pain persists, an MRI allows early diagnosis and targeted interventions
  • There is also a genetic predisposition to osteoarthritis and rheumatism
  • Facet & ISG syndrome should be diagnosed as early as possible and treated in a targeted manner
  • After targeted ISG / facet interventions, an individualized, specific follow-up treatment is essential