Facet joints of the cervical spine. Facet syndrome, as a result of disorders in the joints and bones. The course of minimally invasive operations for facet joint syndrome

Most people explain any acute and chronic back pain, although they do not even know anything about this disease. In fact, this concept is quite broad, and combines a whole group of degenerative diseases of the spine. At the same time, localization pathological changes can be located in one or several articulations that connect the vertebrae.

The most common lesion of the facet joints of the spine is detected in X-ray examination in 52% of young and 88% of elderly patients. These joints are located in the posterior segment of the spinal column, connecting the above and the underlying vertebrae. Although they do not carry a significant burden, degenerative changes begin in them first of all.

Depending on the severity and severity of the development of symptoms, the disease (facet syndrome) is divided into acute and chronic forms. Also, only two localizations of the pathology are possible - in the cervical or lumbar. Despite the division of forms, the principles of treatment in each case are approximately the same. The only difference is the duration of therapy, as well as the methods of drug administration.

Anatomy

Facet joints are a peculiar and "informal" name for the facet joints that connect the vertebrae in the posterior segment. Although they have a fairly simple structure, it is precisely the mechanism of their work that attracts. Therefore, we should consider them more from the point of view of functional anatomy:

The basis for the joint are paired articular processes of neighboring vertebrae, which have small areas covered with cartilage in the region of the tops.
The articulation capsule has small size, attached exactly along the edge articular surfaces. The shape of the articular cavity depends on the department - in the neck and chest it has a transverse position, and in the lumbar vertebrae it is oblique.

The connection is strengthened by nearby tendons and muscles - the posterior longitudinal ligament, as well as small muscles that hold the transverse processes.
The shape of the facet joints, depending on the spine, also changes. In the cervical and thoracic segments, they are considered flat, while the lumbar vertebrae are connected by a cylindrical type of joints.
During flexion or extension of the spine, the facet joints perform only sliding movements relative to each other. Therefore, they belong to the group of sedentary compounds.
According to biomechanics, the joints are considered combined, like other joints of the spine. This means that movements simultaneously occur not only in the symmetrical joints of one vertebra, but also in neighboring segments.

It is the peculiarities of the shape and mobility of the facet joints that make them the weakest link in the supporting complex of the spinal column.

Pathology

To make it easier to understand why a facet joint is needed for the spine, the concept of a support complex should be touched upon. Its isolation is associated with the heterogeneous structure of the vertebra - the load is not distributed over its entire area, but falls only on certain points:

There are three such sections - front, middle and rear support pillars.

The anterior complex experiences the maximum pressure - it includes the main part of the vertebral body.
But during movements, the load is almost evenly transferred to the back, which includes the longitudinal ligament of the same name and the facet joints.
Since the articular surfaces of these joints and the intervertebral disc are not comparable in size, the main pressure is on the soft tissues - the capsule and ligaments.
Accordingly, with a sudden overload, their damage may occur, which will clinically manifest itself as an acute facet syndrome.
Regular exposure becomes the cause of a chronic lesion, which, by the nature of the manifestations, practically does not differ from osteochondrosis of the cervical or lumbar region.

The leading symptom of the disease in each case is pain, which leads to moderate or significant limitation of mobility, and the appearance of stiffness in the neck or lower back.

Acute

The basis of this variant of the disease is inflammation of the facet joint -. Its occurrence is associated with trauma, leading to acute damage to the articular membranes. In this case, the following mechanisms occur in the joint:

Sudden damage rarely occurs in people who have a completely healthy spine. Therefore, for its development, some degenerative changes regarding soft tissues are still required.
Regular excessive loads and lack of training lead to a significant weakening of the muscular and ligamentous apparatus in the area of facet joints.
Excessive mobility appears in the joints associated with stretching of its membranes.
With a sharp and atypical load, a sharp displacement of the articular surfaces can occur, which will cause local damage to the ligaments.
Then the reaction immediately follows. nervous system- there will be a response spasm of the muscles trying to stabilize the vertebrae. At this point, the first sign of pathology will appear - pain.
After some time, inflammation will develop in the area of damage - a protective mechanism aimed at restoring defects in soft tissues. Involvement in this process of the joint is accompanied by the appearance of symptoms of osteoarthritis.

Timely and correctly provided assistance in acute facet syndrome is the main prevention of adverse consequences.

Chronic

The development of this form of the disease is fully consistent with the idea of most people about osteochondrosis. Degenerative processes in the joints reach their clinical debut - and it is no longer the pain syndrome that comes to the fore:

The chronic form may be a consequence of the acute course of the disease, or develop independently. Moreover, in the second case, the development of symptoms occurs so gradually that patients often do not pay attention to them for a long time.
In the joints, under the influence of sluggish inflammation, there is a continuous process of destruction of the articular cartilage.
Both of these processes are interrelated - each stimulates the preservation of the other.
Therefore, in order to stop this vicious circle, the body decides to completely close the pathological focus - it triggers the mechanisms of arthrosis.
Simultaneously with the replacement of damaged cartilage with bone tissue, there is a significant compaction of the surrounding ligaments and the joint capsule. Therefore, the symptoms of impaired mobility come first, and pain can become their consequence.

It is impossible to stop the course of arthrosis in the facet joints - all treatment methods are aimed only at slowing down this process as much as possible.

Symptoms

Considering the listed options, two most typical onsets of the disease can be distinguished. Their timely separation allows you to choose the optimal method of treatment, which allows you to partially or completely eliminate the manifestations:

The first case is a relatively young patient (about 40 years old), leading sedentary image life. And, all of a sudden, his back had to undergo significant physical activity - for example, gardening or lifting weights. In this case, an acute onset of the disease is usually observed, and pain in 88% of cases is localized in the lumbar region.
The second case is old man who already has signs (obvious and hidden) of arthrosis of other joints. At the same time, he may be disturbed to varying degrees by local stiffness and pain that occurs during movements in the spine. Since the process in this case is systemic and chronic, the disease equally affects the cervical and lumbar regions.

Symptoms of the disease almost always have common features with other lesions of the spine, which makes it difficult to accurately and timely diagnose.

cervical

Manifestations of the facet syndrome in this localization are usually chronic. It will differ from typical osteochondrosis in the absence of a characteristic radicular syndrome - pain along the nerve fibers. Although on early stages they can be very similar:

The pain syndrome is always strictly limited, and is determined only in the projection of the affected joint.
Unpleasant sensations are aching or stabbing in nature, and are determined on the back of the neck directly above the spine or slightly away from it.
The pain will actually be point, and the patient will even be able to point this place with his finger, and not with his palm (unlike osteochondrosis).
Pressure on the spinous process closest to the location of the pain will lead to increased discomfort.
There is a noticeable limitation of the mobility of the head to the sides, as well as in the anteroposterior direction. When trying to carry out a full-fledged movement, the patient feels an obstacle that does not allow him to complete it completely.
Concomitant symptoms - headaches, dizziness - are observed only with combined development with osteochondrosis of other departments.

The acute occurrence of such manifestations is more characteristic of myositis - local inflammation of the small muscles surrounding the spine.

Lumbar

Although this localization of the disease is much more common, patients with both acute and chronic forms rarely seek medical help. They get used to living with manifestations, only sometimes trying to eliminate them. folk ways:

The pain syndrome rarely has significant intensity, having significant strength only with the acute onset of symptoms.
Unpleasant sensations are also always localized in the area of the affected joint, sometimes spreading a little lower. But the irradiation of pain is not characteristic of the facet syndrome - or to the lower extremities.
The pain syndrome almost always has a monotonous and aching character, intensifying when trying to move, as well as in an uncomfortable static position. Therefore, patients often report an important diagnostic information that their pain increases with prolonged standing.
Stiffness in both cases is functional in nature - that is, it is impossible to perform a sharp movement, but they manage to make a slow tilt or extension of the lower back.

It is important to conduct a differential diagnosis with an intervertebral hernia, which can also be disguised as this disease.

Treatment

The main direction of assistance in each variant of the disease is the suppression of the inflammatory process in the articular tissues, which will eliminate all symptoms. Therefore, the first stage of treatment can take place according to the following options:

In most cases, the symptoms can be eliminated after the course (Diclofenac, Ketoprofen). They are prescribed in a combined form - a short course of injections is given, after which the patient takes pills for a few more days.
In rare cases, another combination is prescribed - treatment starts immediately with taking the medicine inside. At the same time, it is combined with topical application of anti-inflammatory and (gels and ointments).
With persistent pain, the question of the need for a blockade is decided. A local anesthetic in combination with a hormone (hydrocortisone or) is injected into the area of the affected joint with a long needle.

In parallel, stabilizing procedures are applied - the patient must wear an adjustable corset for some time. It will remove some of the load from the affected joint, giving it the opportunity to fully recover.

Rehabilitation

After the suppression of the pathological mechanisms of inflammation, the prevention of their re-development begins. For this, various methods of physiotherapy are used, which allow partially or completely to restore mobility to the facet joints:

First, more gentle procedures are applied that do not have a pronounced reflex effect. Therefore, patients are prescribed electrophoresis or phonophoresis with novocaine and calcium, a laser or a magnet.
In parallel with them, classes begin therapeutic gymnastics, in which the principle of stepwise increase in loads must be observed.
Gradually, you can move on to techniques that are characterized by a stimulating effect on the back muscles. To do this, apply to the paravertebral region with paraffin and ozocerite, inductothermy, electrical myostimulation.
Massage is the last to be introduced into the rehabilitation program, since its early appointment contributes to the occurrence of reflex pains. Therefore it various options shown only after sufficient preparation of the muscles of the back.

Wearing a soft brace or collar after recovery is recommended but not required. But for the prevention of relapses, you should still wear them at least before the upcoming atypical physical activity.

Facet syndrome is a manifestation of arthrosis of the intervertebral (facet) joints. Osteoarthritis of the facet joints cannot develop on its own, it is always a running degenerative-dystrophic process that affects the intervertebral discs, vertebrae and everything around them. And if they say that it occurs in 15-40% of all patients with chronic lumbar pain, then this figure is clearly significantly underestimated, because this syndrome cannot have changes in the intervertebral discs. And all patients with intervertebral hernias have manifestations of arthrosis of the facet joints in varying degrees of severity. And what, everyone needs to be operated on? But who got better after radiofrequency denervation of the facet joints? We haven't met them. Why it happens that they continue to treat the symptoms of the facet syndrome, and not its cause, is not clear even today. Let's try to understand these intricacies of the anatomy of the spinal column.

The vertebral bodies, intervertebral discs, anterior longitudinal ligament are designed to resist gravity, and the transverse and spinous processes, lamina, pedicles and intervertebral joints are designed to protect against rotational and lateral and anteroposterior displacement forces.

The force of gravity in the normal spinal motion segment is unevenly distributed: up to 80% on the anterior sections and up to 30% on the intervertebral (facet) joints.

With the defeat of the intervertebral discs, its height and shape change, the vertebrae become closer to each other. And naturally, the articular surfaces of the intervertebral joints also become closer, their joint space becomes narrower. Of course, the entire weight load is transferred to them, reaching 70%. This overload leads to changes in them. First, to synovitis with fluid accumulation, and then to degeneration of the articular cartilage, stretching of the joint capsule and subluxation in it. These repeated microtraumas, weight and rotatory overloads lead to periarticular fibrosis and the formation of subperiosteal osteophytes. Due to this, the dimensions of the upper and lower facets increase. Then the joints sharply degenerate and practically lose cartilage. Due to the asymmetry of the process, the loads on the facet joints are uneven. Changes in the intervertebral discs and facet joints severely limit movement in the spinal motion segments.

Pain begins during extension and rotation of the lumbar spine during torsion overloads. The pain is limited to the area above the affected joint in the lumbosacral region, rarely this pain is referred and cramping, sometimes it radiates to the buttock and upper thigh. One of the symptoms of facet syndrome may be short-term morning stiffness, followed by an increase in pain in the evening. From prolonged bending, changing the position of the body, with long standing, extension, the pain intensifies, but unloading the spine with certain postures reduces pain.

On examination, the patient reveals smoothness of the lumbar lordosis (and what is strange here - the curves of the spine are formed before the age of 7), curvature and rotation of the spine in the lumbosacral and thoracic-lumbar regions, pronounced tension of the paravertebral muscles and the square muscle on the diseased side, muscle tension popliteal fossa and hip rotators. Palpation of the affected joint is painful. With facet syndrome, reflex, motor, sensory disorders are very rare and the symptoms of "stretch" are not characteristic, as with radicular syndrome, and there is no restriction of movement in the legs. Sometimes, in chronic cases, some weakness of the rectifiers of the spine and the muscles of the popliteal fossa is revealed.

The facet joints are innervated from 2-3 adjacent levels, which seriously complicates the diagnosis.

Methods of treatment of arthrosis of the intervertebral joints

To date, the most effective method treatment of not only symptoms, but also the facet syndrome itself, radiofrequency denervation is considered, when the pathological process, it seems, is eliminated by exposure to electromagnetic field wave frequency in the vicinity of the affected joint and after an hour the patient can leave the clinic. But tomorrow, or maybe even on this day, all the same pains that tormented him before come back to the patients. Yes, because the cause of the developed arthrosis has not been eliminated. In our clinic, we are constantly faced with such cases. And believe me, it is quite difficult to treat such patients with facet syndrome. Especially in the beginning, when faith in healing is at its lowest. It appears only when the entire staff of the clinic makes great efforts not only in treatment, but also morally helps to cope with the problem. Such patients always become our friends and even friends. And the patients try not to remember the operation, because at that time, it was theirs - the wrong choice.

Facet syndrome is one of the most common problems with the spine. Almost half of the cases of pain in the lumbar region are a symptom of this pathology. But since pain is not the only problem, and as the disease progresses, it can cause a serious deterioration in the quality of life, it is very important to know the main signs of the disease and the principles of its treatment.

At the heart of the disease, facet syndrome is a violation of individual joints of the spine. One of the main reasons for this phenomenon is a significant decrease in the space between the vertebrae during dehydration of the intervertebral discs. As a result of such pathological processes, cartilage tissue is destroyed, and the capsules of the facet joints are unnaturally strongly stretched, contributing to joint subluxations.

As a result of the destruction of the facet, a large number of problems with the musculoskeletal system appear, accompanied by pain. The appearance of the pain factor is provoked primarily by the close proximity of the nerve roots to the damaged joints.

Very often, such pathological conditions as arthrosis and subluxation of the intervertebral joints, lumbar syndrome, osteoarthritis, and spondyloarthritis are also included in the facet syndrome.

Causes

Almost any mechanical damage to the joints of the lumbar spine can provoke facet syndrome. In addition, its development is also affected by inflammatory processes of any nature that occur in it and are located in the immediate vicinity of the tissues.

The main causes of facet syndrome include:

spondylitis of tuberculous type;
rheumatoid arthritis and other persistent inflammatory processes that occur in the joints;
spondyloarthritis;
microtrauma in the lumbar spine;
arthrosis of the intervertebral joints;
gout and pseudogout;
metabolic disorders in the tissues of the vertebral joints;
obesity.

Sudden movements can easily provoke compression of the joint capsule between two vertebrae, which also contributes to the development of facet syndrome. It is also a risk factor elderly age when the nutrition of the joints is significantly reduced. In addition, intensive sports with the need to apply significant loads, as well as work requiring weight lifting, also often become the causes of the development of the facet syndrome.

Symptoms

The main symptom of this disease is the appearance of pain. In this case, the pain can be absolutely of any nature and occur in various parts of the back. However, facet syndrome of the lumbar spine is most often observed. In addition, pathology is always accompanied by an inflammatory process, which can be detected during a diagnostic examination. In this case, the inflammatory process develops not only at the site of damage to the facet tissues, but also gradually covers other vertebrae.

Also, the main symptoms of the disease are:

almost constant tension of muscle tissue in the area of damage;
smoothing of the lumbar lordosis;
a feeling of crunching in the spine during any movements;
increased pain when bending back and to the side;
point soreness of the inflammation zone, determined by palpation of the area that causes discomfort.

In some cases, the facet syndrome is accompanied by atypical phenomena in the form of a complete absence of any symptoms, up to a normal level of nerve root tension.

With the disease, exacerbation of symptoms is periodically observed. And in the case of a long absence of proper treatment, irreversible destruction of the joints occurs. This process is accompanied by significant weakness in the muscles. They quickly lose their elasticity, while it becomes extremely difficult for the patient to sit and stand.

Features of the manifestation of a pain symptom

Being the main sign of pathology, pain in facet syndrome, most often, is concentrated in one place and is accompanied by some limitation of muscle mobility.

The occurrence of acute pain in the neck or lumbar region, most often manifests itself with a break of several weeks or even months. It happens that the exacerbation occurs only once a year.

Diagnostics

Due to the fact that the symptoms of facet syndrome are very similar to those of other diseases, its diagnosis is quite difficult. Often only a very experienced doctor is able to immediately detect such a problem.

Diagnosis of pathology by a doctor always begins with an analysis of the patient's complaints, as well as a thorough study of the medical history, for the primary identification of the cause of the development of the disease. In addition, an external examination and palpation of the painful area is mandatory. And to confirm the diagnosis, a hardware examination is used using such devices:

x-ray;
computed tomography (CT);
magnetic resonance imaging (MRI).

Almost always, X-ray examination is combined with diagnostics on CT or MRI machines. This is necessary due to the fact that the x-ray image allows you to see only the shape and position of the vertebrae. And for a detailed examination of them for damage, computer and magnetic resonance imaging are used. It is the use of such diagnostic methods that provides an accurate diagnosis.

Treatment

The procedure for treating such a disease as facet syndrome requires the obligatory elimination of the cause of the pathology. This is how therapy can bring the maximum positive effect.

Facet syndrome can be treated conservatively or surgically.

Conservative treatment

Conservative treatment is necessarily carried out in a complex manner, and includes the following therapeutic procedures:

taking anti-inflammatory medicines non-steroidal type, prescribed by the attending physician strictly individually;
visit to the manual therapy room;
use of physiotherapy methods;
performing exercises of special physical therapy, which allows you to strengthen the muscles of the lower back, as well as correct posture.

In the course of treatment, it is imperative to reduce the load on the diseased lumbar joint as much as possible. This can be done by reducing the time spent walking, as well as reducing the time spent in a sitting and standing position. With sedentary work and lifestyle, a patient with facet syndrome needs to take breaks as often as possible and a special warm-up for muscles and lumps.

As the main drugs in the treatment of facet syndrome, the following are used:

Nurofen;
Ortofen;
Diclofenac.

The exact treatment, as well as the selection of drugs for such a disease, should only be a competent attending physician. The use of drugs during the treatment of facet syndrome allows not only to stop the development of the inflammatory process, but also to stop pain, as well as to ensure an increase in the level of nutrition and tissue regeneration.

Surgery

The lower back of a patient suffering from facet syndrome requires treatment in a cardinal way, in the form of an operation, in the case when even long-term conservative treatment does not give a stable positive result. Such cardinal therapy can be represented by such types of manipulations:

radiofrequency elimination of nerve endings in the area near the destroyed facet tissues;
forced replenishment of periarticular fluids;
coagulation of nerve endings.

The choice of a specific method of therapy always directly depends on the timeliness of seeking medical help, as well as general condition patient's health. And in view of the seriousness of the consequences of the pathology in the absence of treatment, it is very important not to postpone a visit to the doctor.

Facet syndrome is one of the most common spinal problems. Almost half of the cases of pain in the lumbar region are a symptom of this pathology. But since pain is not the only problem, and as the disease progresses, it can cause a serious deterioration in the quality of life, it is very important to know the main signs of the disease and the principles of its treatment.

Very often, such pathological conditions as arthrosis and subluxation of the intervertebral joints, lumbar syndrome, osteoarthritis, and spondyloarthritis are also included in the facet syndrome.

Causes

The main causes of facet syndrome include:

spondylitis of tuberculous type;
rheumatoid arthritis and other persistent inflammatory processes that occur in the joints;
spondyloarthritis;
microtrauma in the lumbar spine;
arthrosis of the intervertebral joints;
gout and pseudogout;
metabolic disorders in the tissues of the vertebral joints;
obesity.

Sudden movements can easily provoke compression of the joint capsule between two vertebrae, which also contributes to the development of facet syndrome. Also a risk factor is advanced age, when the nutrition of the joints is significantly reduced. In addition, intensive sports with the need to apply significant loads, as well as work requiring weight lifting, also often become the causes of the development of the facet syndrome.

Symptoms

Also, the main symptoms of the disease are:

almost constant tension of muscle tissue in the area of damage;
smoothing of the lumbar lordosis;
a feeling of crunching in the spine during any movements;
increased pain when bending back and to the side;
point soreness of the inflammation zone, determined by palpation of the area that causes discomfort.

In some cases, the facet syndrome is accompanied by atypical phenomena in the form of a complete absence of any symptoms, up to a normal level of nerve root tension.

Features of the manifestation of a pain symptom

Being the main sign of pathology, pain in facet syndrome, most often, is concentrated in one place and is accompanied by some limitation of muscle mobility.

The occurrence of acute pain in the neck or lumbar region, most often manifests itself with a break of several weeks or even months. It happens that the exacerbation occurs only once a year.

Diagnostics

x-ray;
computed tomography (CT);
magnetic resonance imaging (MRI).

Treatment

The procedure for treating such a disease as facet syndrome requires the obligatory elimination of the cause of the pathology. This is how therapy can bring the maximum positive effect.

Facet syndrome can be treated conservatively or surgically.

Conservative treatment

Conservative treatment is necessarily carried out in a complex manner, and includes the following therapeutic procedures:

taking non-steroidal anti-inflammatory drugs prescribed by the attending physician strictly individually;
visit to the manual therapy room;
use of physiotherapy methods;
performing exercises of special physical therapy, which allows you to strengthen the muscles of the lower back, as well as correct posture.

As the main drugs in the treatment of facet syndrome, the following are used:

Nurofen;
Ortofen;
Diclofenac.

Surgery

radiofrequency elimination of nerve endings in the area near the destroyed facet tissues;
forced replenishment of periarticular fluids;
coagulation of nerve endings.

The choice of a specific method of therapy always directly depends on the timeliness of seeking medical help, as well as the general health of the patient. And in view of the seriousness of the consequences of the pathology in the absence of treatment, it is very important not to postpone a visit to the doctor.

How do people deal with back pain? young age, and the elderly. But in older people, severe cases of pain are more common. Over time, pains begin to prevail, which are provoked by degenerative changes in bone and cartilage tissues.

Facet syndrome (spondylarthrosis) is a form of osteoarthritis that develops in the intervertebral joints. This syndrome combines a whole group of pathological conditions with different clinical manifestations, the basis of which is damage to the structures of the facet joints. The tactics of treating facet syndrome depend on the causes that caused it.

Etiology and pathogenesis

The facet syndrome includes diseases of the spine that affect the intervertebral joints (arthrosis, acute arthritis, subluxation of the joints, and others). Some experts share the concepts of "facet syndrome" and "spondylarthrosis" and consider the latter to be a more extensive concept. With facet syndrome, only the facet is destroyed, and spondylarthrosis is associated with the destruction of all articular structures.

Facet joints are located between the surfaces of the bone of the upper process of the joint of one vertebra and the lower articular process of the adjacent one. The motor function of the joint provides lateral tilt, flexion and extension forward and backward, rotation.

Facet joints undergo significant stress. Gradually, the elastic core of the intervertebral disc - a shock absorber for the spine, loses its properties due to the depolarization of vigorous saccharides. With age, the supply of the disc with essential microelements is reduced, it loses water. Along with this, its elasticity and mobility worsens, the height decreases.

This causes a gradual shift of the weight load from the discs to the joints, which can be up to 70%. Overloaded joints begin to accumulate synovial fluid between the facets, the joint capsule stretches, and the cartilage degenerates.

Localization of the facet syndrome:

cervical region - about 50% of cases;
lower back - 30%;
in other cases, it is the thoracic region, shoulder girdle, gluteal zone.

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Reasons for the development of pathology

Facet syndrome can be the result of various pathological conditions:

degenerative process in vertebral structures;
rheumatoid arthritis;
tuberculous form of spondylitis;
gout;
vertebral microtrauma;
dislocations and subluxations of the joints;
lack of nutrition of articular tissues;
violation of the metabolic process, for example, in obesity;
diabetes;
clamping of the joint capsule due to unsuccessful movements.

The risk group includes:

patients with systemic infections;
elderly people;
young people who experience great physical exertion (for example, when doing weightlifting);
leading an inactive lifestyle, as a result of which the joints lose the opportunity to develop and strengthen.

First signs and symptoms

Patients characterize the pain of peri facet syndrome as dull, blurry. It does not extend below the knees. Severe cases of the disease may be accompanied by paroxysmal burning, shooting pains that mimic sciatica.

The dynamics of pain during the day changes. Usually in the morning there is a short-term pain, which after a certain physical activity subsides. But by the end of the day, the intensity of the pain syndrome increases again.

The change in the nature of joint pain is associated with certain loads. It can be provoked by certain positions and body movements. When changing the position of the body, the pain syndrome subsides. With lumbago, for example, the pain is always sudden, a change in body position does not affect its intensity.

The progression of the facet syndrome causes a decrease in the mobility of the spine. Pain in this pathological condition is not permanent, but recurs several times a year. Moreover, each relapse, as a rule, is longer than the previous one.

In addition to pain, facet syndrome is characterized by inflammation in the affected joints. This can be detected during X-ray or tomography. The inflammatory process leads to weakening of muscle tissues, loss of their elasticity.

Facet syndrome is also accompanied by:

smoothing the physiological lumbar lordosis;
muscle spasm in the affected area;
painful sensations during palpation of the inflamed areas;
crunching in the vertebrae during movement.

On a note! main feature facet syndrome - pain. It can vary in nature and intensity. More often, the lumbar region is subjected to pain syndrome, since it is more mobile, the joints in this area wear out faster. Pain in lumbar facet syndrome can radiate to the buttock and thigh, lower abdomen, along the course of innervation of the nearest spinal roots.

Diagnostics

If a person notices that painful conditions recur, it is imperative to conduct an examination to confirm or exclude the presence of facet syndrome.

Conducted research:

Radiography with contrast;

Thanks to computed tomography, articular structures can be well visualized. Unlike CT, MRI is a less informative technique for diagnosing facet syndrome, the study is more suitable for diagnosing intervertebral hernias.

General rules and methods of treatment

Only a doctor can determine how to treat facet syndrome after finding out the exact cause of the pathology.

Conservative therapy

It includes the use of drugs to relieve the symptoms of the syndrome, as well as restorative techniques. The main task of drug therapy is to stop the pain syndrome.

Commonly prescribed drugs:

ibuprofen;
Diclofenac;
Ortofen;
Celecoxib;
Celebrex.

It is better to take drugs in the form of tablets or injections. With facet syndrome, the application of external agents is ineffective.

Additionally, to stop the signs of the syndrome, use:

physiotherapy exercises to strengthen the muscular corset and correct posture;
physiotherapy to stop the inflammatory process, relieve pain;
manual therapy and massage to improve blood supply to the facet joints and restore mobility.

Surgery

One of the most effective radical treatments for facet syndrome is radiofrequency denervation. Pathological changes are eliminated by exposure to electromagnetic radiation on diseased joints.

The operation does not involve the use of general anesthesia and incisions. The duration of the operation is about 30 minutes. On the same day, the patient can go home.

The method of facetoplasty is also used. A certain amount of synovial fluid is injected into the destroyed facet joint. This allows the joint to regain its functionality.

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To reduce the likelihood of developing facet syndrome, you must regularly follow some recommendations:

move more;
do therapeutic exercises every day;
do not overload the spine;
avoid prolonged sitting in a sitting position;
prevent injury to the structures of the spine.

Facet syndrome is a complex of pathological conditions, which are based on damage to the facet joints. With age, the disease tends to progress and relapse. It is better to do prevention of vertebral pathologies as early as possible and prevent the development of the disease.

Video about the causes, symptoms and features of facet syndrome therapy:

Facet joint syndrome is a disorder characterized by pathological changes in the tissues of the intervertebral (facet) joints. This syndrome accompanies arthrosis and in the course of the disease, damage occurs not only to the intervertebral discs, but also to the vertebrae and other nearby tissues.

This disease affects 85-90 people out of a hundred who have reached old age. However, the syndrome can begin to develop much earlier, at 30-35 years old, if a person suffers from congenital pathologies of the spine.

Pathogenesis and mechanism of development

The disease affects all components of the joints of the spine (cartilage, ligaments, muscles) and this leads to the appearance of pain. What happens to the spine affected by this disorder?

If we talk about the functions of the spine, it should be noted that the purpose of the vertebrae, discs and anterior ligaments is to resist gravity. And the role of protection against displacement is assigned to the intervertebral joints, plates, as well as the transverse and spinous processes. The distribution of gravity is as follows: about 80% falls on the anterior sections of the spine, on the joints - up to 20%.

When facet syndrome affects the intervertebral discs, the distance between the vertebrae changes to a smaller side and due to this, the load increases. The appearance of microtraumas and degenerative changes in the joints follows.

In this case, the mobility of the spine is limited, and pain appears.

Why does facet syndrome occur?

Facet syndrome is not an independent disease, but most often occurs as a result of various disorders in bone, joint and cartilage tissues, or after injuries. The causes of the development of the syndrome can be:

Availability diseases associated with disorders of metabolic processes(for example, with gout and pseudogout);
chronic inflammation due to arthritis(with rheumatoid arthritis and spondyloarthritis);
dystrophic changes in the joints and malnutrition of tissues (for example, with spondylarthrosis);
presence of tuberculous spondylitis and other systemic infectious diseases;
subluxations, microfractures, ruptures of capsules and cartilage in the joints.

As a rule, the disorder develops slowly, but with some types of injuries, most often sports, the syndrome can develop much faster.

Locations by spine

Due to the anatomical features of the structure of the spine, facet syndrome can be localized in the following areas:

cervical region - 55%;
region lumbar - 30%;
pain syndrome is less common in the shoulder and gluteal region, also pain can be given to the head and limbs.

Pain sensations in facet syndrome increase in the process of flexion of the limb, while extension is characterized by their decrease.

As a rule, pain extends to the elbows and popliteal fossae. Often there is also morning stiffness in the spine and limbs.

Clinical picture

The main symptoms of facet syndrome are:

pain in the area of damaged joints and partial loss of muscle elasticity in the back;
acute pain of an unpredictable nature in the spinal and cervical region;
discomfort when bending, and bending back causes more discomfort than bending forward;
with the localization of the syndrome in the cervical region, pain can radiate to the shoulder and upper back, sometimes reaching the hands;
if changes occur in the lumbar region, discomfort occurs in a “sitting” position, and the more time a person spends sitting, the more painful the sensations and the stronger the muscle spasms.

Interestingly, it is impossible to predict what strength, frequency and duration of pain attacks will be. It can appear suddenly and just as suddenly disappear.

Diagnostic methods

It is possible to diagnose facet syndrome both on examination by a specialist, based on the patient's complaints, and using various diagnostic methods.

Most often, an x-ray examination is prescribed, which allows you to determine what causes the pain syndrome.

If X-ray examination does not provide a complete picture of the disease, computed tomography (CT) is used. This method is aimed at a detailed study of the affected area of the spine.

The effectiveness of magnetic resonance imaging (MRI) in detecting facet syndrome is low, but this method is indispensable for suspected spinal disc injuries or herniation.

Complex of therapeutic measures

The main goal of treatment for facet syndrome is to relieve the patient of pain attacks and normalize the processes and tissues of the spine. Both conservative and surgical treatments are used.

Conservative treatment

The basis of the conservative method is drug therapy and physiotherapy. Taking medication can significantly reduce pain and improve the quality of life of the patient.

In the treatment of the syndrome, it is advisable to use such drugs:

Ortofen;
Nurofen;
ibuprofen;
Diclofenac;
Celebrex.

Drugs are prescribed in the form of tablets and injections, gels and ointments are ineffective in such cases. The listed medications can reduce acute and chronic pain, sometimes for a fairly long time, and are also aimed at combating inflammatory processes in the spine.

Physiotherapy treatments are also designed to relieve pain and reduce inflammation.

For problems with the spine, physiotherapy exercises are effective. A specially selected set of exercises helps to restore biomechanics, form the correct posture, strengthen muscles and ligaments.

Manual therapy is also used, the purpose of which is to reduce pain and restore mobility in the affected parts of the spine.

In addition to the above methods, it is recommended to wear cervical collars, the use of orthopedic pillows and frequent rest breaks, especially if the patient has to spend most of the time sitting. Most often, conservative methods of treatment give a positive effect, but especially severe cases require surgical intervention.

RF denervation method

Radiofrequency denervation is used as a surgical treatment for facet joint syndrome. It consists in the elimination of pathological changes by electromagnetic effects on the affected joints.

In most cases, this procedure does not require general anesthesia, and there is no need for incisions in the skin. The operation lasts about half an hour, after which the patient is able to leave the hospital on his own on the same day.

Like any disease, facet syndrome requires immediate and adequate treatment; when the first signs of discomfort appear in the cervical or lumbar spine, you should immediately seek help from specialists.

Self-medication or ignoring the symptoms can lead to a number of unpleasant complications. Pathological processes will progress, which will entail all sorts of serious disorders in the functioning of the musculoskeletal system, the consequences of which are unpredictable.

How to insure the maximum?

Approximately 80% of people of different ages have to deal with manifestations of the facet syndrome. For this reason, it is not necessary to talk about completely eliminating the possibility of its occurrence.

However, it is possible to significantly delay its onset and reduce the intensity of pathological processes. You can keep your spine healthy for many years if you follow these recommendations:

to live an active lifestyle;
exercise daily;
visit the pool;
walk more;
avoid spinal injury.

It is important to remember that any disease is easier to prevent than to treat and not neglect prevention.

Most people explain any acute and chronic pain in the back as osteochondrosis, although they don’t even know anything about this disease. In fact, this concept is quite broad, and combines a whole group of degenerative diseases of the spine. In this case, the localization of pathological changes can be in one or several joints at once, which connect the vertebrae.

Depending on the severity and severity of the development of symptoms, the disease (facet syndrome) is divided into acute and chronic forms. Also, only two localizations of the pathology are possible - in the cervical or lumbar region. Despite the division of forms, the principles of treatment in each case are approximately the same. The only difference is the duration of therapy, as well as the methods of drug administration.

Anatomy

The basis for the joint are paired articular processes of neighboring vertebrae, which have small areas covered with cartilage in the region of the tops.
The joint capsule is small in size, attaching exactly along the edge of the articular surfaces. The shape of the articular cavity depends on the department - in the neck and chest it has a transverse position, and in the lumbar vertebrae it is oblique.
The connection is strengthened by nearby tendons and muscles - the posterior longitudinal ligament, as well as small muscles that hold the transverse processes.
The shape of the facet joints, depending on the spine, also changes. In the cervical and thoracic segments, they are considered flat, while the lumbar vertebrae are connected by a cylindrical type of joints.
During flexion or extension of the spine, the facet joints perform only sliding movements relative to each other. Therefore, they belong to the group of sedentary compounds.
According to biomechanics, the joints are considered combined, like other joints of the spine. This means that movements simultaneously occur not only in the symmetrical joints of one vertebra, but also in neighboring segments.

It is the peculiarities of the shape and mobility of the facet joints that make them the weakest link in the supporting complex of the spinal column.

Pathology

There are three such sections - front, middle and rear support pillars.
The anterior complex experiences the maximum pressure - it includes the main part of the vertebral body.
But during movements, the load is almost evenly transferred to the back, which includes the longitudinal ligament of the same name and the facet joints.
Since the articular surfaces of these joints and the intervertebral disc are not comparable in size, the main pressure is on the soft tissues - the capsule and ligaments.
Accordingly, with a sudden overload, their damage may occur, which will clinically manifest itself as an acute facet syndrome.
Regular exposure becomes the cause of a chronic lesion, which, by the nature of the manifestations, practically does not differ from osteochondrosis of the cervical or lumbar region.

The leading symptom of the disease in each case is pain, which leads to moderate or significant limitation of mobility, and the appearance of stiffness in the neck or lower back.

Acute

At the heart of this variant of the disease is inflammation of the facet joint - osteoarthritis. Its occurrence is associated with trauma, leading to acute damage to the articular membranes. In this case, the following mechanisms occur in the joint:

Sudden damage rarely occurs in people who have a completely healthy spine. Therefore, for its development, some degenerative changes regarding soft tissues are still required.
Regular excessive loads and lack of training lead to a significant weakening of the muscular and ligamentous apparatus in the area of facet joints.
Excessive mobility appears in the joints associated with stretching of its membranes.
With a sharp and atypical load, a sharp displacement of the articular surfaces can occur, which will cause local damage to the ligaments.
Then the reaction of the nervous system will immediately follow - there will be a response spasm of the muscles trying to stabilize the vertebrae. At this point, the first sign of pathology will appear - pain.
After some time, inflammation will develop in the area of damage - a protective mechanism aimed at restoring defects in soft tissues. Involvement in this process of the joint is accompanied by the appearance of symptoms of osteoarthritis.

Timely and correctly provided assistance in acute facet syndrome is the main prevention of adverse consequences.

Chronic

The chronic form may be a consequence of the acute course of the disease, or develop independently. Moreover, in the second case, the development of symptoms occurs so gradually that patients often do not pay attention to them for a long time.
In the joints, under the influence of sluggish inflammation, there is a continuous process of destruction of the articular cartilage.
Both of these processes are interrelated - each stimulates the preservation of the other.
Therefore, in order to stop this vicious circle, the body decides to completely close the pathological focus - it triggers the mechanisms of arthrosis.
Simultaneously with the replacement of damaged cartilage with bone tissue, there is a significant compaction of the surrounding ligaments and the joint capsule. Therefore, the symptoms of impaired mobility come first, and pain can become their consequence.

It is impossible to stop the course of arthrosis in the facet joints - all treatment methods are aimed only at slowing down this process as much as possible.

Symptoms

The first case is a relatively young patient (about 40 years old) leading a sedentary lifestyle. And, all of a sudden, his back had to undergo significant physical activity - for example, gardening or lifting weights. In this case, an acute onset of the disease is usually observed, and pain in 88% of cases is localized in the lumbar region.
The second case is an elderly person who already has signs (obvious and hidden) of arthrosis of other joints. At the same time, he may be disturbed to varying degrees by local stiffness and pain that occurs during movements in the spine. Since the process in this case is systemic and chronic, the disease equally affects the cervical and lumbar regions.

Symptoms of the disease almost always have common features with other lesions of the spine, which makes it difficult to accurately and timely diagnose.

cervical

The pain syndrome is always strictly limited, and is determined only in the projection of the affected joint.
Unpleasant sensations are aching or stabbing in nature, and are determined on the back of the neck directly above the spine or slightly away from it.
The pain will actually be point, and the patient will even be able to point this place with his finger, and not with his palm (unlike osteochondrosis).
Pressure on the spinous process closest to the location of the pain will lead to increased discomfort.
There is a noticeable limitation of the mobility of the head to the sides, as well as in the anteroposterior direction. When trying to carry out a full-fledged movement, the patient feels an obstacle that does not allow him to complete it completely.
Concomitant symptoms - headaches, dizziness, numbness of the hands - are observed only with combined development with osteochondrosis of other departments.

The acute occurrence of such manifestations is more characteristic of myositis - local inflammation of the small muscles surrounding the spine.

Lumbar

The pain syndrome rarely has significant intensity, having significant strength only with the acute onset of symptoms.
Unpleasant sensations are also always localized in the area of the affected joint, sometimes spreading a little lower. But the facet syndrome is not characterized by irradiation of pain - backache along the lower back or into the lower extremities.
The pain syndrome almost always has a monotonous and aching character, intensifying when trying to move, as well as in an uncomfortable static position. Therefore, patients often report an important diagnostic information that their pain increases with prolonged standing.
Stiffness in both cases is functional in nature - that is, it is impossible to perform a sharp movement, but they manage to make a slow tilt or extension of the lower back.

It is important to conduct a differential diagnosis with an intervertebral hernia, which can also be disguised as this disease.

Treatment

In most cases, symptoms can be eliminated after a course of non-steroidal anti-inflammatory drugs (Diclofenac, Ketoprofen). They are prescribed in a combined form - a short course of injections is given, after which the patient takes pills for a few more days.
In rare cases, another combination is prescribed - treatment starts immediately with taking the medicine inside. At the same time, it is combined with the local use of anti-inflammatory and warming agents (gels and ointments).
With persistent pain, the question of the need for a blockade is decided. A local anesthetic in combination with a hormone (Hydrocortisone or Diprospan) is injected into the area of the affected joint using a long needle.

Rehabilitation

First, more gentle procedures are applied that do not have a pronounced reflex effect. Therefore, patients are prescribed electrophoresis or phonophoresis with novocaine and calcium, a laser or a magnet.
In parallel with them, classes in therapeutic gymnastics begin, in which the principle of a stepwise increase in loads must be observed.
Gradually, you can move on to techniques that are characterized by a stimulating effect on the back muscles. For this, applications are applied to the paravertebral region with paraffin and ozocerite, inductothermy, electrical myostimulation.
Massage is the last to be introduced into the rehabilitation program, since its early appointment contributes to the occurrence of reflex pains. Therefore, its various variants are shown only after sufficient preparation of the back muscles.

Wearing a soft brace or collar after recovery is recommended but not required. But for the prevention of relapses, you should still wear them at least before the upcoming atypical physical activity.

Facet syndrome of the spine is a very common pathology and most cases of back pain occur precisely in it. As it progresses, it is able to provide increasing Negative influence on the body and significantly worsen the quality of life of the patient. In this article, we will consider how the facet joints of the spine manifest themselves, what clinical picture they form and how effective their treatment is.

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Definition

Facet syndrome is a disease of the articular tissue of the spine. It is localized in a particular department and affects several vertebrae at once. The pathogenesis is that the tissue of the intervertebral discs is dehydrated, as a result of which they become thinner, and the distance between the vertebrae is significantly reduced. Over time, the cartilage tissue is completely destroyed, and the capsules of the facet joints are greatly elongated. This leads to the development of subluxation of each affected joint.

Damaged joints and involvement in the process of nerve roots (their pinching) lead to the appearance of pain and other problems with the musculoskeletal system. As more and more nervous tissue is involved in the process, more serious symptoms may develop, such as paralysis, paresis, numbness, etc.

Sometimes arthrosis, snodyloarthritis, osteoarthritis, lumbar syndrome and subluxations of the intervertebral joints of various nature are also classified as facet syndrome.

It is a question of a syndrome, instead of an independent disease. That is, such changes in the intervertebral discs, causing the corresponding symptoms, develop against the background of one or another underlying pathological process. By itself, such a syndrome as a primary disease cannot manifest itself.

Causes

This syndrome can be caused big amount reasons, both serious and relatively not too dangerous. In most cases, these are chronic diseases of the spine associated with changes in the articular and / or bone tissue occurred for one reason or another. Most often, facet arthrosis of the spine is caused by such conditions:

Gout and pseudogout;
Rheumatoid arthritis;
Tuberculous spondylitis;
Spondyloarthritis.

But also changes can occur as a result of malnutrition of the articular tissue due to any vascular diseases. Microtraumas of one or another part of the spine can lead to the formation of facet syndrome.

Localization and % of all cases

The syndrome usually affects several vertebrae at once, but within the same spine. Statistically revealed that the incidence of pathology in a particular section of the spine in patients is not the same.

The cervical region is more prone to this pathology than others - it accounts for 50% of all cases of this syndrome;
In second place is the lower back - it accounts for 30% of all cases;
The shoulder, thoracic and sacral regions are most rarely affected - they share the remaining 20% of cases.

Men and women are equally susceptible to pathology. But in children, the syndrome is much less common, since the corresponding diseases of the spine are not common among them. In older patients, this condition develops most often, since they are more susceptible to diseases that cause the syndrome, and also because failures and changes occur in their body that can cause it on their own (malnutrition of the joints of the spine, etc.).

Symptoms and signs

Depending on which part of the spine the lesion is located in, its symptoms can vary significantly. When localized in the lower back are observed:

Pain in the lower back, aggravated by bending over, long walking or long standing, sitting;
Gradual decrease in lumbar mobility;
Rapid numbness of the legs, tingling in them;
Pain of a aching nature, eroding into the thigh;
Paresis and paralysis lower extremities in advanced cases.

With localization in the neck, the symptoms are different:

Pain during prolonged writing, or working at a computer, sharp turns of the head;
Diffuse aching pain that can erode into the hands;
feeling of numbness in the neck;
Tension and spasm of the neck muscles;
Headaches associated with vascular spasm.

With sacral localization, the symptoms are similar to signs of a lesion in the lumbar zone. But problems with the intestines and bladder. With damage to the intervertebral discs in the thoracic and shoulder regions, aching pain also occurs, which increases with sudden movements, eroding into the hands. There may be weakness of the hands, their numbness, tingling in them, paresis and paralysis in advanced cases.

Diagnostics

The condition is diagnosed using the following methods:

History taking and analysis of symptoms;
Examination of the patient, checking the sensitivity at certain points;
Radiography with contrast;
Electroneurography;
CT and MRI (if necessary).

Methods help to accurately establish the localization, degree of development, as well as the cause of the pathology.

Treatment

Treatment of arthrosis of the facet joints of the spine is carried out in a complex manner, using different approaches and methods. The main method is conservative, with the use of medications, but surgical methods can also be used in some cases.

Anesthetics and corticosteroids

With the help of such drugs, severe pain attacks are stopped. Sometimes novocaine blockade is done to patients. It brings a fairly long-term relief, but sooner or later the pain still comes back. Corticosteroids are also used for significant pain. Drugs such as Prednisolone, Hydrocortisone also effectively relieve inflammation and pain. Steroid cream Advantan is prescribed for application 2-3 times a day.

Analgesic drugs and non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs are prescribed to relieve not too intense pain and inflammation.

Ibuprofen or Nurofen are taken 1 tablet three times a day for 10 days;
Diclofenac in injections is administered 1 injection once a day, at a dosage depending on the patient's weight;
Voltaren - the cream is applied 3-4 times a day, 2-3 grams.

Also, analgesics (Analgin, etc.) can be used for pain relief.

Physiotherapy

It is important, as it strengthens the muscular frame and normalizes blood circulation. Complexes must be prescribed by a doctor. The most common of these includes the following exercises:

Lying on your back, knees bent, hands in front of you. Knees stretch to the right, palms to the left. Then vice versa. Repeat 6 times in each direction;
Lying on your back, knees bent. Raise your knees to the sides, towards the floor. Repeat 5 times;
Lying on your back, knees bent, legs apart. As you exhale, lower your knees inward alternately. Repeat 5-6 times with each leg;
Lying on your back, knees bent. Pull your knees to your chest alternately, 5 times with each leg;
The same as in the previous exercise, but after pulling up, straighten the leg;
Standing on your knees and palms. Rock your body back and forth five times in each direction.

During exacerbations, exercise therapy is contraindicated.

Physiotherapy

Physiotherapy relieves inflammation, normalizes blood circulation. The following procedures are applied: microwave, UHF, electrophoresis with various preparations. It can be used only during periods of remission and only as prescribed by a doctor, as an addition to other methods of treatment. By itself, it is not a treatment.

Manual therapy

This group includes various methods manual exposure, from massages to acupuncture. Such methods help to strengthen the muscular frame, increase muscle tone, relieve their spasm. They normalize the blood supply to the joints. Thanks to massages, the flexibility and mobility of the damaged sections are restored, and pain is reduced.

Orthopedics

During an exacerbation, it is very important to reduce the load on the affected area. For this, orthopedic corsets can be used in case of localization of the process in the shoulder or thoracic regions, belts in case of localization in the sacrum or lower back, collars, if facet syndrome of the cervical region is diagnosed. It is also recommended to sleep on orthopedic mattresses and pillows. This helps to speed up treatment and not provoke new exacerbations.

rhizotomy

This is a blockade of the nerve endings of the facet joints. This procedure is carried out at very severe pain and gives a fairly long lasting analgesic effect. It is carried out under X-ray control.

Botox

Botox injections contribute to the paralysis of some local muscles of the musculoskeletal system. Thanks to this, it is possible to normalize muscle tone and avoid spastic manifestations, which lead, in most cases, to the occurrence of a pronounced pain syndrome.

Surgical intervention

It is carried out in cases where conservative treatment does not give a stable result. The following types of manipulations are carried out:

Forced replenishment of joint fluids;
Cauterization of nerve endings to eliminate pain symptoms;
Radiofrequency removal of nerve endings in the pinched area for the same purpose.

Measures are taken in combination or separately. Surgical intervention is used extremely rarely.

Forecast

With a weak degree of severity, conservative treatment gives a fairly good, stable result. With timely treatment of the cause of the syndrome, it is possible to achieve complete relief from pain. Surgery also provides an almost complete guarantee of pain relief.

Complications and consequences

If untreated, dehydration leads to the fact that the intervertebral discs are completely destroyed. This leads to a loss of flexibility and mobility of the spine, slippage of the vertebrae. As the nervous tissue is involved in the process, a chronic pain syndrome occurs, numbness of the extremities and disruption of the functioning of some organs (various, depending on the localization of the process) may develop. Paresis and paralysis are possible.

Prevention

Specific prevention is to maintain endocrine system in a healthy state. It is also important to lead a moderately active lifestyle, to avoid hypodynamia. But it is equally important to avoid overloading the spine and its injuries. If any negative symptoms appear on the part of the musculoskeletal system, consult a doctor in a timely manner to prescribe treatment.

Conclusion

Facet syndrome is a sign of the development of a more serious disease. But in and of itself, it can cause significant discomfort. Therefore, it is important to consult a doctor for help in a timely manner.