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Facet Joint Syndrome Overview

The spine is a complex structure kept strong and flexible by the vertebrae, which are small, circular bones stacked on top of one another. Each vertebra is separated from the next one by a soft shock-absorbing disc of cartilage known as an intervertebral disc and connected by two facet joints. 

These joints, which are also known as zygapophyseal joints, play a vital role in providing flexibility to the spine and preventing excessive motion, such as abnormal rotation. The facet joints are lined with cartilage, which protects the bones from shock and friction damage. 

Facet joint syndrome occurs when this cartilage wears down or deteriorates, allowing the bones to come into contact during movement, thus causing pain, inflammation, reduced range of motion, and permanent damage to surrounding structures.

Facet joint syndrome occurs in up to 60% of cases of whiplash injury. But, besides traumatic injury, other risk factors for this condition exist, including: 

  • Age-related degeneration of cartilage
  • Repetitive or forceful movements (e.g. throwing motions) that speed up the deterioration of cartilage
  • Arthritis 
  • Overuse and excessive stress (e.g. due to obesity)
  • Mechanical problems and poor posture that change the mechanics of the spine
  • Genetic conditions, such as malformations of the cartilage

Symptoms Of Facet Joint Syndrome

The facet joints are responsible for enabling spinal movements such as flexion, extension, and rotation, simultaneously protecting you from the damage that may occur if you overextend or over-rotate the spine. If these joints don’t work as they should, you’ll experience a range of symptoms, including:

  • Pain during movements such as sitting, bending, or rotating your torso
  • Reduced flexibility and range of motion
  • Nerve pain and damage, which may occur if the bones, stripped of their protective cartilage, pinch or irritate nearby nerves in the spinal cord. Nerve pain can also appear as shooting sensations, extreme sensitivity to touch, cramps, and numbness. 
  • Abnormal bone growth, known as bone spurs, may develop in the spine as the body attempts to repair damaged tissues. Bone spurs can change the mechanics of the spine and lead to further restriction of the range of motion. 

Facet joint syndrome can affect any vertebrae in the spine. However, most commonly, this condition affects the lumbar (or lower) spine in the L4 and L5 spinal segments.

Depending on which facet joints are affected, you may have:

  • Cervical (neck) facet joint syndrome
  • Thoracic (middle section of the spine) facet joint syndrome
  • Lumbar (low back) facet joint syndrome

The symptoms of these conditions may be localized to the areas affected at first. However, over time, further deterioration of the spine components can impair your posture and gait, cause generalized back pain, and affect your ability to perform movements such as bending or sitting.

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Conventional Treatment Options

Minor injury to the spine can cause facet joint pain lasting from two weeks to 12 months. But if facet joint syndrome is caused by cartilage malformation or degeneration, the pain and reduced range of motion can become lifelong symptoms. 

In the long term, relying on traditional treatments – usually pain medications or surgery – can expose you to severe risks and side effects, including infections, stomach ulcers, increased risk of stroke and heart attack, and addiction.

Below are the most common treatments prescribed for facet joint syndrome. 

Corticosteroid Injections

Corticosteroids are the synthetic version of cortisol, a hormone naturally produced in the body by the adrenal glands. When used in the management of chronic pain, steroids work by inhibiting the activity of the immune system, which, in turn, reduces the production of chemicals that cause inflammation. Corticosteroid injections can cause a range of side effects, including weight gain, mood changes, muscle weakness, blurred vision, increased appetite, acne, osteoporosis, and sleep problems. 


NSAIDs – or nonsteroidal anti-inflammatory drugs – are pain medications generally available as an over-the-counter alternative (e.g. ibuprofen). They work by blocking the cyclooxygenase (COX) enzyme, which is responsible for making prostaglandins. 

Prostaglandins are chemicals that amplify pain signals and cause tissue swelling in response to injury or disease. By blocking the production of prostaglandins, NSAIDs can reduce inflammatory symptoms like swelling, pain, and fever. 

When taken long term, NSAIDs increase the risk of heart attack and stroke, they can cause stomach ulcers and may lead to kidney dysfunction. 

Spinal Fusion

Spinal fusion is a major, highly invasive surgery used if all other treatments have failed. In this surgical procedure, two or more of the vertebrae are fused together, usually using bolts or screws. The intervertebral disc located between the vertebrae is removed and replaced by bone-like material, which will keep the spinal bones in place. 

Depending on what vertebrae are affected by facet joint syndrome, patients may undergo cervical fusion surgery (which fuses some of the neck bones) or lumbar fusion surgery (which fuses together some of the low back vertebrae, usually, L4 and L5). 

Given the risks involved and the lengthy recovery process involved, spinal fusion is only recommended in severe cases, such as if the diseased facet joints are causing spinal instability or disability. In cases where the pain derives from deteriorating intervertebral discs, just over a quarter of patients undergoing spinal fusions report a successful outcome.

What’s more, spinal fusion does not prevent future back pain, and having a spine that does not move in certain areas can strain other parts of the spine or of the body. 


Facetectomy is a type of surgery used to trim and reshape parts of the facet joint. It is used to remove excess bony growths, such as bone spurs. It is recommended if these bony growths have started to prevent spinal movement or impinge on nerves in the spinal cord. 

Nerve Ablation

Usually performed using radiofrequency, nerve ablation is used to burn the nerve endings of the joint capsule, which are responsible for transmitting pain signals from the diseased area to the brain. 

After a diagnostic nerve block, which is used to determine which nerves are causing chronic pain, radiofrequency current is delivered directly to nerve fibers using an electrode. Although this procedure may provide long-lasting pain relief, it does not address the cause of facet joint pain, nor does it prevent further damage to the spinal components.

What Is Platelet-Rich Plasma, Or PRP? 

Platelet rich plasma – or PRP – is a blood sample taken from the patient and processed to concentrate the platelets in the plasma. The platelets are cell fragments responsible for clotting, which is an essential step in the healing process of wounds.

Platelets also contain a high concentration of growth factors. You can think of growth factors as “espresso shots” that repair cells can use to heal and regenerate damaged tissue. These growth factors, which in platelets live in “packets” known as alpha granulate, stimulate the activity of other repair cells and can attract repair cells to the injured area from across the body.

PRP contains concentrations of platelets above the baseline values of normal blood. Because of this, platelet-rich plasma injections represent a simple, safe, and minimally invasive method of delivering growth factors to damaged areas.


PRP For Facet Joint Syndrome 

PRP treatments are a form of regenerative medicine that leverages high concentrations of the blood’s healing factors injected into damaged tissues to support the body’s ability to repair itself. 

In regenerative orthopedics, this therapy is used to treat muscle strains, ligament and tendon tears, minor arthritis, and joint instability. So far, there have been more than 30 randomized controlled trials that show how PRP is capable of helping the body heal itself by stimulating the stem cells within the targeted injured area. 

In the treatment of facet joint syndrome, PRP represents a safe and efficient treatment option that does not involve invasive procedures, side effects of medications, or risks such as allergic reactions. According to a 2016 study, in the three months after injection, nearly 80% of patients with lumbar facet joint pain achieved a significant reduction in pain and improved mobility. Additionally, a 2017 prospective study concluded that PRP is a “superior treatment option for longer duration efficacy” compared to corticosteroid injections for facet joint syndrome.


Why Are Orthagenex PRP Injections Superior?

Patient satisfaction and treatment outcomes are the number one priority at Orthagenex. That’s why we have pioneered a superior PRP injection procedure.

This procedure uses platelet-rich plasma produced in specialized laboratory settings, making each injection purer, more concentrated, and entirely customizable to the needs of each patient. Additionally, we use image guidance for precision. 

Let’s look at the details that make a difference below.

Image Guidance To Place PRP Solutions

At Orthagenex, PRP procedures are performed by specialized physicians using ultrasound guidance and fluoroscopy (or a combination of both) to precisely deliver concentrations of platelets and growth factors to the site of the injury. 

  • Ultrasound guidance: Ultrasound guidance provides a real-time visual aid of the position of the needle from the moment it enters the skin. This form of imaging guidance can reduce reliance on tactile sensations and ensure the accuracy of needle placement.
  • Fluoroscopy: C-arm fluoroscopy is a type of X-ray that allows doctors to obtain X-ray images in real time, while injecting PRP into the site of the injury. 

This is in stark contrast with most other orthopedic practices, which perform injections blindly, without any form of image guidance – or sometimes without the necessary training to interpret results. According to research, not using image guidance or lacking sophisticated training can result in trained physicians missing the target location 20-40% of the time. 

The use of imaging guidance to accurately and correctly place PRP or bone marrow concentrate is today known as interventional orthopedics, a new medical specialty based on three key pillars:

  • Using injectates to facilitate the healing of musculoskeletal tissues
  • Ensuring the precise placement of injectates into damaged structures using imaging guidance
  • The eventual development of new tools to facilitate percutaneous tissue manipulation

Lab Processed for Higher Concentrations of Platelets

To offer higher concentrations of platelets, as well as purer and more customized injections, Orthagenex takes advantage of the lab-processed PRP solutions. To understand how this works, let’s look first at how most standard orthopedic clinics create PRP. 

Usually, PRP is created using a simple bedside centrifuge (spinning machine). In the US especially, most clinics offering PRP therapies will collect a sample of the patient’s blood and process it using the centrifuge to separate the plasma and concentrate the blood platelets. Immediately after, the PRP is extracted and injected into the injury site. 

Not only are these bedside automated machines inefficient in offering high concentrations of platelets, but they are also inferior at eliminating undesired cells in the resulting mixture. 

In contrast to these standards, Orthagenex uses lab-processed PRP. This protocol leverages the same approach of other PRP procedures to heal injured tissue. However, the injections are not created by an automated bedside machine, but in a state-of-the-art cellular lab environment by a skilled technician. 

These laboratory procedures are refined to concentrate the blood’s favorable components and remove unfavorable ones. The higher the platelet concentrations are, the more stimulating the effect injections will have on stem cells in the injured area.

  • Concentration of platelets: Lab-processed PRP vs. standard bedside machines

Bedside centrifuges magnify platelet count by two to five times, but typical results are closer to two to three times the normal concentration of platelets found in your blood. Oppositely, lab-processed PRP delivers concentrations of platelets 10-30 times the normal number of platelets!

Amber PRP vs. Red PRP

Two types of PRP can be used for injections:

  • Red PRP: Red PRP, also known as leukocyte rich or LR-PRP, also contains concentrations of white and red blood cells. 
  • Amber PRP: Amber PRP, also known as leukocyte-poor or LP-PRP, contains low concentrations of white and red blood cells.

Both mixtures have high concentrations of platelets. However, it is important to understand the impact that red and white blood cells can have on patient outcomes. 

According to our lab tests, automated centrifuges offer mixtures that still contain white and red blood cells. These cells have been seen to have inhibiting effects on stem cells – which are the same cells platelets are attempting to stimulate. In turn, less pure injections have a counteractive effect and can cause excessive inflammation after the procedure. 

At Orthagenex, we use amber LP-PRP. This is because amber LP-PRP has also been shown to cause less injury to the synovial cells in the knee than red LR-PRP, have a more stimulating effect on cartilage cells, and offer better healing outcomes.

Next-Generation Platelet Lysate (PL)

Alongside PRP, Orthagenex also offers platelet lysate (PL) injections. Platelet lysate is an even more advanced and efficient variation of platelet-rich plasma. Here’s the difference to keep in mind:

  • Platelet-rich plasma releases growth factors to the area of injury over time, usually a week.
  • Platelet lysate immediately releases growth factors en masse to the site of the injury.

Unlike PRP, which can trigger inflammation, PL is remarkably anti-inflammatory. This makes it a more suitable option to treat areas around nerves and the spinal cord. 

Oppositely to standard orthopedic clinics, which are just starting to learn about PL, Orthagenex is already using the third and fourth generation of platelet lysate injections – and we are advancing the efficacy of our mixtures continuously.

PRP Customized To Every Patient’s Need

Not all injuries – or their symptoms – are alike, and they can have a uniquely profound impact on a patient’s life. Because of this, there can’t be a single, standardized treatment for everyone. 

At Orthagenex, we leverage the latest advances in regenerative medicine and interventional orthopedics to offer entirely customized solutions to every patient.

Solutions Are Customized Using Lab-Processed PRP 

As more and more orthopedics and chiropractors begin to offer PRP as part of their treatments, it is important to understand that not all platelet-rich plasma injections are created equally.

Unlike most clinics, which use one–size–fits–all bedside centrifuge machines to create PRP, Orthagenex leverages state-of-the-art cellular lab environments, where proprietary lab-processing techniques are performed. 

These facilities – coupled with sophisticated provider training – allow Orthagenex to create PRP mixtures that have the right concentrations of the right cells to treat your specific injury, such as facet joint syndrome caused by cartilage degeneration as opposed to facet joint pain stemming from injury.

Bone Marrow Concentrate (BMC) Can Be Used 

Orthagenex combines platelet-rich plasma injections with bone marrow concentrate (BMC) injections as needed. 

What is BMC? To understand this, let’s look at the role of stem cells. 

Stem cells are an essential component of the human body and play a critical role in the healing of injured tissues, such as bones, ligaments, and tendons. However, due to age or injury, the body may become unable to deliver enough of these cells to the injured area. 

That’s where BMC comes in. In accordance with the principles of Interventional Orthopedics, Orthagenex uses imaging guidance to deliver concentrated bone marrow, rich in stem cells, to the areas in need. The high concentrations of injected stem cells will then stimulate the body’s ability to heal itself.

Doctors Specializing In Interventional Orthopedics

All Orthagenex physicians are musculoskeletal (MSK) specialists and experts in image-guidance injections. Our doctors are also board-certified and fellowship trained in interventional orthopedics. As only 1% of US physicians are trained in interventional orthopedics, our doctors have been able to help more orthopedic patients using our proprietary techniques than any other regenerative medicine clinic worldwide.

Core Competencies

Our core competencies at Orthagenex include:

  • The use of imaging guidance to accurately deliver PRP injections
  • Customized injectates, thanks to the use of our flexible lab platform
  • Purer and more concentrated amber LP-PRP
  • The use of our four-part SANS (stability, articulation, neuromuscular, and symmetry) method of evaluation

Treating musculoskeletal pain that does not have a known cause can result in you enduring the side effects of inadequate medications or overlooking severe underlying conditions. Unfortunately, this is still the case for 90% of patients with back pain. 

That is why, at Orthagenex, our physicians use SANS – a proprietary evaluation method that looks at your musculoskeletal stability, articulation, neuromuscular health, and symmetry. This full, functional analysis helps obtain a clear diagnosis of what’s causing your pain. In turn, SANS can increase the likelihood of choosing the best treatment for your injury and regaining your musculoskeletal health.


Orthagenex – Your Solution To Facet Joint Syndrome 

At Orthagenex, our goal is to help each patient find a treatment program that aligns with their unique symptoms, needs, and goals. Using regenerative and interventional medicine, we are now able to provide next-generation PRP and BMC procedures that can help restore musculoskeletal health efficiently, without surgery or medications.


Now Available In:

Powder Springs, GA | New Lenox, IL

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