Facet Joint Arthropathy
Wear and tear or osteoarthritic changes of the spine typically involve the small joints of the spine know as facet joints. The facet joints are located in the posterior part of the spine and there are two facet joints between the vertebrae of each spinal segment. Facet joints connect each each segment of the spinal column and these joints allow flexion, extension, and rotation of your spine. Synovial fluid lubricates the joints that are surrounded by a capsule of ligaments. For more information and resources go to: http://www.spine-health.com/video/facet-joint-syndrome-video
What Causes Facet Osteoarthritis?
As we age, degenerative changes of the spine causes breakdown of the facet joints that are normally lined with a lubricant (synovial fluid). Arthritis in the facet joints can develop from:
- wear and tear from disc degeneration causes facet joint breakdown
- previous back injury
- fractures
- disc problems
These additional stressors can cause disruption of the facet joint capsule allowing leakage of the synovial fluid and breakdown of the cartilage which contributes to facet joint pain and inflammation.
What are the Symptoms of Facet Arthropathy
Back pain and stiffnes that may be worse with twisting or bending backwards. Patients typically describe difficulty getting out of bed, chairs, thier car etc. Pain and stiffnes is localized to the lower back and buttocks and does not usually radiate down the legs unless spinal stenosis also is involved.Cervical facet syndrome causes pain and stifness in the neck. Patients may describe a clicking, grinding, or cracking sensation when turning thier head from side to side.
How is Facet Arthropathy Diagnosed?
X-rays, CAT scans or MRI scans are used to help diagnose facet arthropathy. Another procedure which is more specific is performing an X-ray guided injection using a fluroscope. Contrast(dye) may be injected into the joint followed by a small amount of anesthetic and cortisone (steroid). Pain relief within 24-48 hours helps confirm facet joint mediated pain.
How is Facet Arthropathy Treated?
Certain oral medications may be prescribed including:
- Tylenol
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- muscle relaxants
- corticosteroids
Other treatment options include:
- core strengthening excercise
- traction
- aquatherapy
- spinal manipulation
Injections and Surgical Options Include:
- Injections of anesthetic or steroid medication in and around the facet joints or nerves that supply each facet joint
- Facet Radiofrequency (RF) or rhizotomy to denervate the nerves that supply each facet joint.
- Surgery is rare but minimally invasive options exist including fusion.