Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms and disability for patients. However, facet joint problems rarely involve the spinal nerves.
Back Conditions that may be Confused with Facet Joint Problems
Interestingly, when the acute lumbar or cervical facet joint inflammation is at its peak, the symptoms may closely imitate those of a herniated disc, a deep infection, a fracture or a torn muscle of the spine, or in the low back, sometimes an acute intra-abdominal problem. Clearly, such episodes can be very disabling and frightening.
On the other hand, serious problems in the abdomen may mimic lumbar facet joint problems and deep anterior neck problems may imitate cervical facet disorders, so a good differential diagnosis must rule out such things. True arthritis as a source of facet degeneration and pain can also be involved and this possibility should be examined.
A correct diagnosis must await subsidence of the acute problem. Symptoms may include the following:
Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. Patients are often left with the notion that this is a psychosomatic problem, and it may even be implied that “it’s all in your head.”
In the lumbar case, standing may be somewhat limited but sitting and riding in a car is the worst. So-called “limited duty” (sitting) assignments for patients with low back pain are paradoxically bad. When at its height of pain and disability, the muscle spasm is so continual that it fatigues the muscles, which in turn, repeats the cycle.
When the almost unpredictable painful episodes recur on a monthly basis or more often, plain anterior-posterior (front-back), lateral (side view) and oblique (off angle) X-ray films should be made and examined. Usually the abnormal facet changes can be seen. However, aCT scan can obtain more information about not only the facet joints but also other structures of the spinal segment.
The MRI scan is not quite as useful for diagnosing this particular spinal problem, but is extremely helpful when investigating possible disc or abdominal pain contributors.
Perhaps the most definitive diagnosis of facet joint pain can be made by a facet joint injection (or facet joint block), which injects the suspicious facet joints with a small volume of a combination of x-ray contrast material, local anesthetic and cortisone. Relief of the acute or chronic problem during the time of action of this combination of drugs is diagnostic.