The facet joints, as true synovial joints, were first postulated as an etiology of low back pain and sciatica more than 90 yr ago (1-3). It was not until 1933, however, that the facet joints themselves were reported to be the source of the back pain, at which time the term "facet syndrome" was coined by Ghormley (4). More recent studies have provided physiologic evidence that the facet joints do indeed cause back pain as well as referred pain to the buttocks and lower extremity in the lumbar region and the head and shoulder girdle in the cervical region (5-7). Back pain presumed caused by facet syndrome has been attributed to distension and inflammation of the synovial capsule, resulting in stimulation of nociceptive nerve fibers (6). Nerve root compression in the neural foramen or in the spinal canal may be caused by expansion of the synovial recesses (6,8). Many studies have now described the successful relief of back pain after facet joint blocks (912).
The lumbar facet joints act biomechanically to withstand both axial compressive and shearing stresses (13). Disease states that cause degeneration of the intervertebral disc space with concomitant narrowing cause further increased axial loading and shear stresses on the joint (14-16). As the facet joints at all spinal levels are continuous with the posterior border of the adjacent neural foramen, facet joint degenerative changes frequently can be associated with neural foraminal narrowing and concomitant radiculopathy. Trauma, inflammation, infection, degeneration, arthritis, synovial impingement, meniscoid entrapment, segmental instability, and chondromalacia are purported etiologies of facet pain (17,18). Extension and rotation injuries can cause sudden and acute facet joint derangement.
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