Facet joint disease

Definition

The Facet joints are the joint structures that connect the vertebrae to one another. The facet joint is like any other joint in your body – they have cartilage that line the joint, (this allows the bone to glide smoothly over one another) and a capsule surrounding the joint. The function of the facet joint is to provide support, stability, and mobility to the vertebrae (spine). Facet Disease occurs when there is degeneration of the facet joint.

There are two facet joints between each vertebrae. They are located on each side of the vertebrae. Facet disease can occur at any level of the spine, but are most common in the lumbar region.
There are a number of terms that are used to diagnose facet problems:

  • Facet Arthritis
  • Facet Joint Syndrome
  • Facet Disease
  • Facet Hypertrophy
  • Degenerative Facet Joints

In general, all of the terms mean pretty much the same thing – arthritis or degeneration of the facet joint.

Causes

Facet Disease is caused by the cartilage in the joints.  This type of injury to the spine can be attributed to arthritis of the spine, work, over-use or an accident. Another cause of Facet Disease is spondylolithesis, which is when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.

Risk Factors

Primary risk factors: Idiopathic meaning of unknown cause, and senescent or aging: growing old

Secondary risk factors:  Trauma; in this case a physical injury, osteonecrosis or temporary or permanent loss of the blood supply to an area of bone, inflammatory arthritis, and dysplasias meaning an abnormal development (of organs or cells) or an abnormal structure resulting from such growth

Other risk factors: Heredity, gender, diet, obesity, age, physical activity

Symptoms

Symptoms related to facet joint problems are usually localized to the area of the facet joint. This can occur in the cervical (neck), thorasic (mid-back) and lumbar (lower back).

When the facets are affected in the lumbar region, a person can experience lower back pain that can go to the buttocks and upper thigh area. If the area affected is cervical, then pain can occur in the back of the neck and radiate to the top of the shoulders, and can radiate around the neck.

Diagnosis

Mechanical pain is defined as a damaged specific part of the spine, such as an intervertebral disc, a ligament or a joint that is damaged and not working correctly. Most people suffering from back pain suffer from mechanical pain.
 
Significant lower back pain is rarely caused by facet disease because most patients who suffer from facet disease will often have other conditions contributing to their symptoms. Spinal arthritis, degenerative disc disease and often spinal stenosis will often be the contributing factors to facet disease.

When examining a CT scan or a MRI most people with facet joint degeneration will show signs of mild to moderate spinal arthritis in the lumbar area of the spine. To determine whether or not facet disease is a contributing factor to a patient's back pain a bone scan will be done. A bone scan is a test that shows areas of active inflammation in the patient's spine.

Another way to diagnose facet arthropathy would be to selectively inject facet joints with a mixture of local anesthetic and an anti-inflammatory steroid. Once the injection is complete, if the patients back pain show significant improvement and there was evidence in the bone scan, MRI, or CT scan of arthritic facet joints, a diagnosis of facet disease can be made with a good deal of confidence. 

Treatment

Since there are a lot of causes of back and neck pain, it is important that when evaluating and treating a patient that the correct diagnosis is made. Pain related to facet disease can be easily diagnosed. This is accomplished by either a thorough physical exam or a diagnostic facet injection, a numbing medication injected into the facet joint. If your pain is caused from the facet joint, then the pain should resolve immediately. If you still have pain after the injection, then your pain may be caused by something else such as Spinal Stenosis or a herniated/bulging disc, which may require a different procedure to correct.

If the injection relieves the pain, then the next step would be to perform a Laser Facet Thermal Ablation. This procedure is performed through a small tube – 5mm (about the size of a straw.) The laser, fiber optics and irrigation are all placed in the tube and surgery is performed on the facet joint. The surgeon will use the laser to debride (clean the joint) and deaden the nerve that innervates the joint. This is very similar to a root canal that the dentist will perform on your tooth. This procedure takes about 40 minutes and will resolve the pain associated with the facet joint.

Prevention

When considering conservative methods of treatment for the pain and symptoms being caused by facet disease there are several options. Initially the treatment of the facet disease will involve the patient avoiding the movements and motions such as lifting, extension of the lumbar spine or repetitive twisting that are causing the joints to be painful. Strengthening and stretching exercises aimed at improving the strength and endurance of muscles in the lumbar spine region along with a course of anti-inflammatory medications is often the initial approach.

The inflammation caused by facet disease can be relieved through injections reducing the pain and discomfort that the patient is feeling. Pain may recur after several months making this not often a permanent solution for combating the symptoms of facet disease.



Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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