The facet joints are the connections between the bones of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body. These joints also allow the spine to bend and twist, and they keep the back from slipping too far forward or twisting without limits.
- Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults and is thought to be a common cause of back and neck pain.
- The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain.
- While facet arthrosis is a common radiographic finding, which has been suggested to be a potential cause of spinal pain, nearly 10% of all adults show signs of degeneration by the time they reach age 30.
- This study demonstrated a variable age-related prevalence of facet joint pain in chronic low back pain, whereas in the cervical spine it was similar among all the age groups.
¶ C1 and C2 segment (From Spine-health).
The C1 and C2 vertebrae are the first two vertebrae at the top of the cervical spine. Together they form the atlantoaxial joint, which is a pivot joint. The C1 sits atop and rotates around C2 below. More of the head’s rotational range of motion comes from C1-C2 than any other cervical joint.
Examples of conditions that might affect the segment are:
- Arthritis. Arthritis in the C1-C2 joint is common in many of the systemic arthritic syndromes such as rheumatoid arthritis or other spondyloarthropathies (spinal arthritis syndromes). Bone spurs and other degenerative changes may eventually compress a nerve root or the spinal cord.
- Fracture. Fractures of the C1 and C2 vertebrae usually occur together. Fractures may result from MVA, diving in shallow water, falling, motor vehicle accidents, and/or hitting an obstacle with the forehead or chin.
- Vertebral artery injury. Injuries at C1-C2 may affect the vertebral artery at this level while it takes a torturous turn to ascend into the brain. Vertebral artery injuries at this level may lead to serious neurological conditions.
- Occipital neuralgia. Injury to the C2 spinal nerve may result in headaches due to occipital neuralgia.
- Crowned dens syndrome. Calcium from the surrounding ligaments may deposit on the dens of C2. This deposition causes inflammation and reduced mobility of the C1-C2 joint.
- Cervical spondylosis is the most common progressive disorder in the aging cervical spine. It results from the process of degeneration of the intervertebral discs and facet joints of the cervical spine.
Possible symptoms include:
- Radiating pain up to the back and/or top of the head
- Pain in the temple and/or behind the eyes and/or ears
- Neck-tongue syndrome resulting in neck and/or head pain with numbness or abnormal sensation on one side of the tongue
- Sensitivity to light
- Fatigue
- Dizziness
- Nausea
In order to diagnose C1-2 joint pain, it is possible to inject local anesthetic and steroid medication into the joint under x-ray guidance.
See general guidelines for cervical assessment triage here.
Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013 Apr;9(4):216-24. doi: 10.1038/nrrheum.2012.199. Epub 2012 Nov 13. PMID: 23147891; PMCID: PMC4012322.
Manchikanti L, Manchikanti KN, Cash KA, Singh V, Giordano J. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician. 2008 Jan;11(1):67-75. PMID: 18196171.
Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. 2007 Jan;60(1 Supp1 1):S7-13. doi: 10.1227/01.NEU.0000215430.86569.C4. PMID: 17204889.