Facet Syndrome

Facet joint syndrome is a popular scapegoat explanation for chronic back ache when there is no evidence of a more definitive structural pathology to take the blame.

While facet joint degeneration is easy to see on any diagnostic film study, many patients do not know the simple fact that the process is completely normal in the human vertebral column. Doctors conveniently do not typically mention this basic truth either.

Facet Joint Syndrome Diagnostic Process

Imaging studies will look at the actual vertebral bones first. Signs of facet syndrome will be noted. Next, indications of neurological impingement (pinched nerves) will be investigated. Sometimes, the facet joint degeneration can lead to the growth of bone spurs, which might compress a spinal nerve root. The possibility for mechanical pain will also be evaluated.

Once all the data is in, the evidence of whether or not facet joint arthritis may be causative or contributory to the symptoms should be quite clear. However, in many cases, there is little proof of the facet joints being directly causative for pain, so additional steps might be taken to almost forcibly implicate them so the patient can be put into treatment.

Anesthetic Diagnosis of Facet Joint Disease

Research points out that the anesthetic dose is often up to 100 times too large to numb just that individual joint. The anesthetic will spread and can affect all the spinal nerves in the area. This basically blocks pain from any cause in that spinal level. Sometimes multiple spinal levels are numbed. Obviously, this is not a reliable diagnostic technique, but makes a great smoke and mirror routine when a doctor wants something substantial on which to blame the pain.

Anesthetic evaluation and diagnosis can be useful when performed objectively and by a true expert. However, in some cases it is clearly being abused as a modality to convince a patient of a mistaken diagnosis and get them into profitable care.

Recommendation for Facet Syndrome Diagnosis

Do not let some exaggerated mental picture of your poor vertebrae rubbing violently together cause you to have worsened symptoms. Remember, this diagnosis can cause a very powerful nocebo effect.

Always take time to research any diagnosis you receive and be active in learning all you can about the condition. You would be surprised how many patients can prevent misdiagnosis simply by reading about their condition and finding obvious holes in the theory of what is actually causing pain. Many patients find their symptoms do not correlate in location or expression. Others discover another potential cause which makes more sense in their specific circumstances. Often, these patients are right and are justified in questioning the diagnostic blunders.

At the very least, I always recommend seeking a second opinion before getting involved in any ongoing treatment program. If surgery is recommended, I up the advice to get at least 2 more opinions before even considering that potentially risky path.