The facet joint is surrounded by a joint capsule and its inner membrane produces synovial fluid lubricating the joint. The disk and the junction of the two vertebral bodies serve as the inner wall of this foramen. The inner surface of the facet joint serves as the outer wall of the foramen of a spinal nerve, through which it exits. Together with the intervertebral disk and its articulation with the adjacent vertebra they form a three joint complex which stabilizes the spine and allow it to flex, extend, and rotate through a wide range of motion. The superior articular facet faces upward and articulates with the inferior articular facet of the vertebra above. The facet joints in the spinal column are located posterior to the vertebral body. For the purpose of this review, we will be focusing on back pain arising from the facet joint. Traumatic disruption of the facet joints or vertebral body may also predispose to degenerative change and may lead to low back pain. Other predisposing conditions include synovial impingement, meniscoid entrapment, chondromalacia facetae, pseudogout, villonodular synovitis, and acute and chronic infection.Īn increased sagittal-orientation may be the cause or result of degenerative spondylosis. These include structural changes due to disk degeneration, spondylolysis or spondylolisthesis, and also inflammatory joint diseases including rheumatoid arthritis and seronegative arthritis. Several conditions predispose individuals to developing facet joint pain. The majority of cases of facet joint arthropathy are attributable to repetitive stress and low-grade trauma and are often related to age and degeneration of the intervertebral disks. The L4-L5 facet joints are the most commonly and severely implicated with 元-L4 and L5-S1 also often involved. A large epidemiological multicenter study over 5 years in the USA found a prevalence of 4.8% with prevalence rates increasing with increasing age.
Estimation of the prevalence of symptomatic facet joint arthropathy in the general population depends on the diagnostic criteria used and varies from 5% to 15%.
Pain can arise from any structure within the facet joint complex including the fibrous capsule, synovial membrane, hyaline cartilage, and bone. The facet joint has been increasingly implicated as a significant source of pain since it was first described by Goldthwaite in 1911. The etiology of lower back pain is often multifactorial and there are a variety of potential pain generators in the lumbar spine.
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