 The
facet joints connect the posterior elements of the vertebral
bodies to one another. Like the bones that form other joints in the human
body, such as the hip, knee, or elbow, the articular surfaces of the facet joints
are covered by a layer of smooth cartilage, surrounded by a strong capsule of
ligaments, and lubricated by synovial fluid. Just like the hip and the knee, the
facet joints can also become arthritic and painful, and they can be a source of
back pain. The pain and discomfort that is caused
by degeneration and arthritis of
this part of the spine is called facet arthropathy, which simply means a disease
or abnormality of the facet joints.
 Symptoms
Most people who have facet arthropathy will complain of low back pain that is
worse with twisting or extension (bending backwards) of the lumbar spine. The
pain is often quite well localized, and unlike the pain and numbness caused
by a herniated disc or sciatica,
it does not usually radiate into the
buttocks or down the legs. However, as the facet joints become arthritic, they
often develop bone spurs that can decrease the amount of space available for
the nerve roots as they exit the spinal canal. This can be a contributing factor
in the development of spinal stenosis,
which does cause pain, numbness,
and weakness in the buttocks and legs.
Diagnosis
Facet arthropathy is rarely the only cause of significant back low back pain,
and patients who have this condition often have other disorders that may be
contributing to their symptoms, including degenerative
disc disease, arthritis of
other parts of the spine, and often spinal stenosis as well. Most people with
even mild to moderate amounts of arthritis of the lumbar spine will have evidence
of facet joint degeneration on a CT scan (CAT scan) or MRI. A bone scan, which shows areas
of active inflammation in the spine, is a test that can be used to determine
whether or not facet arthropathy may be contributing to a patient's back pain.
The facet joints themselves can be selectively injected with a mixture of a
local anesthetic and an anti-inflammatory
steroid. If this injection relieves a significant amount of the patient's
back pain, and there is evidence to suggest
that the facet joints are arthritic (such as a positive bone scan, CT, or MRI),
then the diagnosis of facet arthropathy can be made with some confidence.
Treatment
There are several options for treating the pain and symptoms caused by facet
arthropathy. The initial treatment of facet joint disease involves avoiding
the motions that cause the joints to be painful (such as repetitive twisting,
lifting, or extension of the lumbar spine), a course of anti-inflammatory medications,
and stretching and strengthening exercises
to improve the strength and endurance of the muscles in the lumbar spine. Injections
can be used to relieve some of the pain and discomfort of facet arthropathy
by quieting down the inflammation and synovitis that is caused by this type
of arthritis. Unfortunately, this is often not a permanent solution, and the
pain may recur after several months. There are a few techniques that have recently
been developed that attempt to alleviate the pain of facet arthropathy by permanently
destroying the nerves that innervate the facet joints and "feel" the pain of
the arthritis. These procedures use small electrical probes that are inserted
through the skin into the area of the nerves to the facet joints, and an electrical
current that destroys the nerve is sent to the tip of the probe. This procedure
is called a sinu-vertebral nerve ablation.
In other situations, surgery may be indicated to relieve the pain of facet
arthropathy. This usually occurs when there is evidence of nerve root compression
from enlargement of the facet joints, or other disorders in the lumbar spine
(such as degenerative disc disease,
spinal instability, or spinal stenosis)
that need to be treated with surgery.
In the course of most forms of a spinal
fusion, the surgeon removes the facet joints between the levels of the spine
that are to be fused together, which effectively eliminates the facet joints
as a source of future symptoms.
Click here to find a doctor who treats facet arthropathy.
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| Published: February 21, 2008 |
Updated: February 21, 2008 |
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