Facet disease occurs when a facet joint in the spine degenerates, most commonly affecting the lumbar region. As the cartilage in the facet joints wears away with age, bone spurs can develop, causing pain, swelling, and stiffness. Non-surgical treatments include rest, physical therapy, and facet joint blocks to diagnose and treat pain. Surgical options include facet rhizotomy to disable sensory nerves, fusion to stop disc and joint problems, or facetectomy to remove bone spurs and decompress nerves. A case study describes a man with left neck and shoulder pain from a septic arthritis infection in his C5-C6 facet joint that was treated with IV antibiotics.

1. S
Facet Disease
A degenerative tale

2. Facet Disease – Anatomical
Components
S Facet Joint
S Facet disease occurs when a facet joint degenerates.
While this can take place at any level of the spine, it most
commonly affects the lumbar region
Video: https://treatingpain.com/condition/facet-syndrome

3. Facet Disease – Who does it
affect?
S Each person’s spinal discs undergo degenerative changes as they age,
but not all people will experience symptoms as a result of these changes.
Symptoms are most commonly seen in 30 to 50 year olds.
S More common in people
S Extreme Overweight
S Overuse due to sport or heavy labor
S Family history of Facet disease
S Presence of disease such as gout (kind of arthritis causing an attack of sudden
burning pain), other types of arthritis, or infections
S Damage stemming from injuries like whiplash, and/or sleeping with a twisted neck
S Sudden jerk of the neck, twisting while lifting overhead, or trauma to the spine

4. Facet Disease – What is
happening Anatomically?
S The joint surfaces are lined with cartilage
allowing them to glide easily over each
other. As we age, the cartilage gradually
wears away, and in many cases, growths
called “bone spurs” can develop.
S When a joint is damaged through
normal deterioration, injury, or
repetitive trauma, it may become
swollen, painful, and stiff. Inflammation
is usually temporary, but in arthritic joints,
it may cause long-lasting or permanent
disability.

5. Facet Disease – What is
happening Anatomically?
S Abnormal bony
growths, called
osteophytes or
bone spurs,
develop on the
vertebrae
S Bone spurs
growing from the
facet joints and
rubbing against the
nerves of the
transverse
foramen.

6. Facet Disease – What
happens biomechanically?
S Friction between the bones leads to the tenderness,
swelling, stiffness, and pain of arthritis.
S Osteoarthritis or degeneration of a facet joint
S The degradation and ware on the cartilage between the
facet joints causes the osteoarthritis

7. Facet Disease – Non-Surgical
Treatments
S Rest, Ice, heat, Physical Therapy
S Good posture
S Anti inflammatory medication
S Facet Joint Blocks – To Diagnose
and to treat. A cervical, thoracic or
lumbar facet joint injection involves
injecting a small amount of local
anesthetic (numbing agent) and/or
steroid medication, which can
anesthetize the facet joints and block
the pain

8. Facet Disease – Surgical
Solutions
S Facet rhizotomy - In this injection
procedure a needle with a probe is
inserted just outside the joint. The
probe is then heated with radio
waves and applied to the sensory
nerve to the joint in order to disable
the nerve. Theoretically, by
deadening the sensory nerve to the
facet joint, a facet rhizotomy
effectively prevents the pain signals
from getting to the brain. A facet
rhizotomy injection is successful in
providing lasting pain relief for
approximately 50% of patients.

9. Facet Disease – Surgical
Solutions
S Fusion - In unusually severe and
persistent problems, degeneration
of the adjoining disc is nearly
always present so the segment may
require a bone fusion surgery to
stop both the associated disc and
facet joint problems. Such surgery
may be considered radical, but an
untreated persistent, episodic,
severely disabling back pain
problem can easily ruin the active
life of a patient and surgery can
therefore be a reasonable choice in
selected cases.

10. Facet Disease – Surgical
Solutions
S Facetectomy and foraminotomy - Lumbar foraminotomy
is a surgical procedure that increases the space around
the neural foramen and relieves compression of the
spinal nerves by removing the disc fragments, overgrown
ligaments and bone spurs from the neural
foramen. Sometimes lumbar foraminotomy is not
sufficient to decompress the nerves and one or more
complete facet joints are also removed, known as
facetectomy. Removal of the facet joints destabilizes the
spine, necessitating a spinal fusion following a
facetectomy.

11. Facet Disease – Surgical
Solutions
S Facet Fixation
S 1.) Removal of lamina
S 2.) Clamp Facets for Drill

12. Facet Disease – Surgical
Solutions
S Facet Fixation
S 3.) Drill
S 4.) Screw

13. Facet Disease – Case Study
S The patient is a 57 year old male with a past
medical history significant for type 2
diabetes mellitus
S left shoulder and neck pain after a trial of
analgesics and muscle relaxants did not
improve his symptoms
Image shows bony destruction at the left C5-C6 facet joint with extension
into both the epidural space and bilateral paraspinal soft tissues

14. Facet Disease – Case Study
S Facet joint septic
arthritis with
extension of the
infection into the
paraspinal
musculature

15. Facet Disease Case Study
S Septic arthritis is most commonly secondary to a bacterial
infection with less common, more indolent infections
resulting from fungal or mycobacterial causes
S He was started on IV Vancomycin and Ceftriaxone, and
was on the medication for 6 weeks.
S On the 6 month check up, there was no evidence of
infection