Facet arthropathy is a common form of arthritis impacting the spine, often causing discomfort and limiting movement. This condition, also known as facet joint osteoarthritis or facet syndrome, involves the degeneration of the small joints connecting the vertebrae in your spinal column. It is a widespread condition, with most individuals developing some degree of it with increasing age, though not everyone experiences pain.
What are Facet Joints?
Facet joints are located at the back of the spine, connecting adjacent vertebrae. These paired joints, two at each spinal segment, enable the spine to bend, twist, and maintain stability. They are synovial joints with a capsule, lubricating fluid, and cartilage-lined surfaces, allowing smooth movement.
The orientation of these joints varies along the spine, influencing the range of motion in different regions. For example, cervical (neck) facet joints allow extensive movement, while lumbar (lower back) facet joints primarily permit flexion and extension. Together with intervertebral discs, facet joints work to distribute loads across the spinal column and prevent excessive motion that could damage the spinal cord and nerves.
Understanding Facet Arthropathy
Facet arthropathy is the degeneration or arthritis of these facet joints. This condition arises when the protective cartilage within the joint wears down, leading to bones rubbing against each other, which causes irritation, inflammation, and pain. The primary cause is age-related wear and tear, as lubricating fluid thins and cartilage erodes over time.
Beyond aging, other factors contribute to the development of facet arthropathy, including previous spinal injuries or trauma. Genetic predisposition and conditions like osteoarthritis also play a role. Poor posture, repetitive movements, and increased stress on the joints from being overweight or obese can accelerate this degenerative process.
Symptoms of facet arthropathy vary depending on the affected spinal region, which can be cervical, thoracic, or lumbar. Common symptoms include localized pain and stiffness, often worse in the morning or after periods of inactivity. The pain may intensify with movements like twisting, standing, or bending backward, and it can sometimes radiate to areas like the buttocks and thighs for lumbar involvement, or shoulders and upper back for cervical cases.
Diagnosing Facet Arthropathy
Diagnosing facet arthropathy begins with a thorough medical history and physical examination. Your doctor will inquire about the nature, location, and factors that influence your pain, and they may ask you to perform specific movements to pinpoint the source of discomfort. Tenderness over the spine may also be assessed, along with basic neurological tests for balance and reflexes.
Imaging tests provide evidence of the joint’s condition. X-rays can show bony changes such as joint degeneration, bone spurs, or narrowing of joint spaces. A computed tomography (CT) scan offers more detailed, three-dimensional images of the bony structures, while a magnetic resonance imaging (MRI) scan provides comprehensive views of soft tissues, including discs, nerves, and inflammation within the joints.
A diagnostic facet joint injection, often guided by fluoroscopy, confirms facet arthropathy. During this procedure, numbing medication, sometimes combined with a corticosteroid, is injected directly into or around the nerves supplying the facet joint. If the injection provides significant, temporary pain relief, it suggests that the facet joint is indeed the source of the pain.
Managing Facet Arthropathy
Managing facet arthropathy aims to reduce pain and improve spinal function, often starting with conservative treatments. Physical therapy is a common initial step, focusing on strengthening the muscles supporting the spine, improving flexibility, and correcting posture. Manual therapy and core stabilization exercises are often incorporated to enhance mobility and reduce discomfort.
Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help alleviate pain and inflammation. For more severe pain, a short course of oral steroids may be prescribed, and muscle relaxants can address associated muscle spasms. Applying heat or cold compresses can also offer temporary relief, with ice used initially to reduce inflammation and heat introduced later to promote blood flow.
If conservative measures do not provide sufficient relief, interventional procedures may be considered. Facet joint injections, which contain a local anesthetic and a corticosteroid, can offer targeted pain relief. Radiofrequency ablation (RFA) is a minimally invasive procedure that uses heat to disrupt the nerve signals transmitting pain from the facet joints, potentially providing longer-lasting relief. In rare cases where other treatments are ineffective and neurological symptoms are present, surgical options such as fusion to stabilize the joint or other procedures to relieve nerve compression may be explored. Treatment plans are always individualized, considering the patient’s specific symptoms, the severity of the condition, and their overall health.