Cervical Facet Syndrome (CFS) is a condition that affects the small joints in the neck, causing chronic pain. It is estimated that cervical facet joints are the source of pain in 49.3% to 60% of patients experiencing persistent neck discomfort. Because the symptoms can mimic simple muscle tension or a general stiff neck, CFS is sometimes initially misdiagnosed.
Understanding the Anatomy and Cause
The cervical facet joints are paired, small synovial joints located at the back of the neck vertebrae. These joints are situated between the bony projections of adjacent vertebrae and are covered with smooth articular cartilage within a fibrous capsule. Their primary function is to guide movement, allowing for flexion, extension, and rotation, while preventing excessive motion that could destabilize the spine.
Facet syndrome occurs when these joints become inflamed, irritated, or damaged. The most common cause is degeneration, often referred to as osteoarthritis or spondylosis, where the protective cartilage wears down over time. As the intervertebral discs lose height, increased pressure is placed on the facet joints, accelerating this degenerative process.
Trauma, such as a whiplash injury, is another significant cause, as the forceful movement can sprain the joint capsule. Repetitive strain from poor posture or occupational activities that require the neck to be held in an extended position can also contribute to chronic irritation. When the joint is damaged, it triggers pain signals carried by small nerves called the medial branches, leading to the symptoms of CFS.
Identifying Common Symptoms
The pain associated with Cervical Facet Syndrome is typically localized to the back of the neck, often described as an aching or dull discomfort. The pain worsens with movements that compress the joints, such as extending the neck or rotating the head to one side. Patients frequently experience tenderness directly over the affected joints, which are located just to the side of the midline.
The syndrome also produces referred pain, meaning the discomfort is felt in areas away from the joint pathology. Depending on the specific joint level affected, this pain can radiate to the shoulders, the upper back, or the base of the skull. For example, irritation of the C2-C3 joint is a common cause of headaches felt at the back of the head and sometimes behind the eyes.
Pain originating from the C5-C6 joint often refers to the lower neck and the top of the shoulder blade (scapula). While facet joint pain can extend into the shoulder and upper back, it generally does not travel past the elbow. This pattern helps distinguish it from radicular pain, which is typically a sharp, shooting pain radiating down the arm due to a pinched nerve root.
Confirming the Diagnosis
Diagnosis begins with a physical examination, where a physician checks for restricted range of motion and tenderness over the facet joints. Imaging studies, such as X-rays, CT, or MRI, are utilized primarily to rule out other causes of neck pain, like disc herniation or fractures. Degenerative changes visible on an image, such as bone spurs or cartilage loss, do not always correlate with a patient’s pain level.
The definitive diagnostic tool is the medial branch block (MBB), a minimally invasive procedure. This involves injecting a small amount of local anesthetic near the medial branch nerves that transmit pain signals from the suspected facet joint. If the temporary numbing of these nerves results in a significant reduction in the patient’s typical pain, the facet joint is confirmed as the source of the discomfort.
To ensure accuracy, physicians often require two separate diagnostic blocks performed on different occasions. This provides confidence that the facet joint is the true pain generator, allowing for more targeted treatment.
Managing Cervical Facet Syndrome
The management of Cervical Facet Syndrome follows a progressive approach, starting with conservative measures. Physical therapy is a fundamental component, focusing on mobility exercises and strengthening the deep neck and supporting muscles to improve stability and reduce stress on the joints. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and reduce inflammation within the joint capsule.
If conservative treatments fail to provide lasting relief, interventional procedures are often considered. A therapeutic facet joint injection involves delivering a mixture of a local anesthetic and a corticosteroid directly into the joint capsule. This injection reduces inflammation and provides pain relief that can last for several months.
For patients who experience temporary relief from diagnostic blocks but whose pain returns, a more durable procedure is radiofrequency ablation (RFA). RFA uses heat generated by radiofrequency waves to create a controlled lesion on the medial branch nerves identified during the diagnostic blocks. This process disrupts the nerve’s ability to transmit pain signals from the facet joint to the brain, providing pain relief that can last for six to twelve months or longer. Surgery is reserved only for rare cases of instability or if all other non-surgical methods have failed to control the pain.