A facet fracture involves a break in one of the small, stabilizing facet joints located between adjacent vertebrae in the spine. These joints are present throughout the spinal column, from the neck (cervical spine) to the lower back (lumbar spine). A fracture in one of these joints can compromise the spine’s integrity and stability, potentially affecting its function and range of motion.
Anatomy and Function of Facet Joints
The human spine is composed of individual bones called vertebrae. Facet joints, also known as zygapophyseal joints, connect adjacent vertebrae at the back of the spinal column. Each vertebra has superior articular facets facing upward and inferior articular facets facing downward, forming joints with the vertebrae above and below.
These small, synovial joints are lined with cartilage and enclosed within a joint capsule, allowing for smooth movement. Facet joints guide the spine’s motion, permitting flexion, extension, and rotation. They also provide stability, limiting excessive movement that could damage the spinal cord or nerves.
Causes and Symptoms of Facet Fractures
Facet fractures commonly result from traumatic injuries, such as those sustained in motor vehicle accidents, falls, or sports-related incidents. Forces causing extreme flexion and axial loading, particularly whiplash injuries, are frequent culprits in cervical spine facet fractures. Degenerative conditions, like osteoporosis, can also weaken bone density, increasing susceptibility to these fractures.
Individuals with a facet fracture often experience severe localized pain in the back or neck, depending on the fracture’s location. This pain typically worsens with movement and can be accompanied by muscle spasms. Neurological symptoms may also arise due to nerve compression or damage, manifesting as numbness, tingling, or weakness in the arms or legs. In severe cases, especially with bilateral injuries, bowel and bladder control issues or even paralysis can occur.
Diagnosis of Facet Fractures
Diagnosing a facet fracture begins with a thorough physical examination and a detailed review of the patient’s medical history. Medical professionals assess the location and nature of pain, evaluate range of motion, and check for any neurological deficits.
Imaging studies confirm the fracture and assess its severity. X-rays provide initial views of bone structures. Computed tomography (CT) scans offer more detailed cross-sectional images and are highly sensitive for identifying spinal injuries, often preferred for visualizing dislocated or locked facets. Magnetic resonance imaging (MRI) is also used to evaluate soft tissue structures, including ligaments, intervertebral discs, and the spinal cord.
Treatment Approaches for Facet Fractures
Treatment for facet fractures varies based on the fracture’s stability, location, and the presence of neurological symptoms. Conservative approaches are often the first line of treatment for stable fractures without significant neurological compromise. This typically involves a period of rest.
Pain management is a significant component of conservative care, which may include over-the-counter pain relievers or prescription medications. Muscle relaxants may be used to reduce spasms. In some instances, targeted injections, such as nerve blocks or facet joint injections, may provide localized pain relief. Physical therapy often begins once acute pain subsides, focusing on gentle range-of-motion exercises, strengthening surrounding muscles, and improving posture. Bracing, such as a cervical collar for neck fractures, may also be used to immobilize the spine.
Surgical intervention is considered for unstable facet fractures, those associated with significant neurological deficits, or when conservative treatments fail. Surgical procedures aim to stabilize the spine, decompress any impinged nerves or the spinal cord, and restore proper alignment. This can involve techniques like spinal fusion, where two or more vertebrae are permanently joined together, often with bone grafts and hardware like screws or rods.
Recovery and Outlook
Recovery from a facet fracture is a gradual process that involves adherence to medical guidance and rehabilitation. The initial healing phase typically involves managing pain and protecting the spine, often with activity modifications. Depending on the severity and treatment approach, this period can range from several weeks to a few months.
Rehabilitation plays a central role in restoring function and preventing long-term complications. Physical therapy sessions focus on progressive exercises to regain strength, flexibility, and mobility in the affected spinal region. Patients are often guided on proper body mechanics and ergonomic practices. The overall prognosis for facet fractures is generally favorable, especially with timely and appropriate treatment, allowing many individuals to return to their previous activity levels.