Occasionally working people with back pain are diagnosed with spinal facet disease or syndrome. Insurance company doctors, the IME doctor, like to say this is a degenerative condition that most people will get it to one degree or another and that its essentially old age. Live with it, case closed. No, fact is, in most people facet degeneration is asymptomatic and one would never know it unless a scan was done. In people who are symptomatic and diagnosed, honest doctors will agree that a worker’s job duties over time can contribute to the formation and acceleration of the facet disease – that it is a work-related condition for which an injured worker should be compensated.
The facet joints are not exactly like a knee or finger joint. Instead, facet joints are the moving connections between the bones in our spine, the vertebrae, which allow us to twist, turn and bend. Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation. Facet joints also prevent each vertebra from slipping over the one below. Facet joints, also called zygapophysial joints, are formed by the top and bottom back sides of each vertebra that stack up to form the spinal column. The large cylinder shaped front of the vertebrae are separated by the intervertebral discs, the jelly donut type shock absorbers.
The facet joints do slide on each other and both sliding surfaces are normally coated by a very low friction, moist cartilage. A small sack or capsule surrounds each facet joint and provides a sticky lubricant for the joint. Each sack has a rich supply of tiny nerve fibers that provide a warning when irritated. Inflamed facets can cause a powerful muscle spasm.
Facet joints are in almost constant motion with the spine and quite commonly simply wear out or become degenerated in many patients. Facet disease is formed when facet joints become worn or torn the cartilage may become thin or disappear and there may be a reaction of the bone of the joint underneath producing overgrowth of bone spurs and an enlargement of the joints.
The joint is then said to have arthritic (literally, joint inflammation-degeneration) changes, or osteoarthritis, that can produce considerable back pain on motion. This condition may also be referred to as “facet joint disease” or “facet joint syndrome.”
A protective reflex arrangement arises when the facets are inflamed which causes the nearby muscles that parallel the spine to go into spasm. We therefore see inflamed facet joints causing crooking and out-of posture of the back, along with powerful muscle spasm.
Diagnosis of facet disease is made given the patient’s symptoms, and confirmed by CT, x-rays or MRI scans, and at times a facet joint injection block.
Facet disease is treated with exercise, physical therapy, medication, chiropractic and lifestyle changes (including job duties at times), nerve ablation and rarely fusion surgery.
While everyone will develop facet disease or syndrome to some extent, if it actually becomes symptomatic or disabling in a working person, a person should consider whether his or her job duties (repetitive bending, twisting, turning) contributed to the condition. If so, a consultation with an experienced worker’s compensation attorney would be advisable.