Bilateral facet arthrosis is a common spinal condition that can cause discomfort and reduced mobility. It involves the wear and tear of specific joints in the spine, affecting their smooth function. This article explores bilateral facet arthrosis, its causes, symptoms, diagnosis, and management.
Understanding Bilateral Facet Arthrosis
The spine consists of vertebrae, connected by small, paired facet joints. These joints provide flexibility and stability, guiding spinal movement. “Bilateral” signifies the condition affects both sides of the spine.
Arthrosis is the degeneration of cartilage cushioning these joints. In bilateral facet arthrosis, this affects both facet joints at one or more spinal levels. As cartilage thins, bones may rub together, causing irritation and inflammation. This can cause bone spurs and joint enlargement. It can occur in the neck, upper back, or lower back.
Causes and Contributing Factors
The natural aging process is a primary cause of bilateral facet arthrosis. As people age, cartilage in the facet joints deteriorates, and lubricating fluid may diminish, increasing friction. While common, age-related degeneration does not always cause pain.
Beyond age, several factors can accelerate this process. Repetitive spinal stress, from occupations involving bending or lifting, can contribute to cartilage breakdown. Poor posture also increases stress on facet joints.
Previous spinal injuries, like trauma or whiplash, can damage joints. Obesity adds significant load to the spine, especially the lower back. Genetic predisposition and inflammatory conditions like rheumatoid arthritis can also play a role.
Identifying Symptoms
Bilateral facet arthrosis typically causes localized pain in the affected spinal region. This pain can manifest in the neck, upper back, or lower back. It often worsens with movements that compress or extend the spine, such as bending backward, twisting, or prolonged standing.
While primarily localized, the pain can also radiate. For instance, cervical facet arthrosis may cause pain extending to the back of the head, ears, or shoulders, while lumbar facet arthrosis can refer pain to the buttocks, hips, or thighs. This radiating pain is generally different from sciatica, as it usually does not follow a specific nerve root pattern or extend below the knee or elbow.
Stiffness, especially in the morning or after inactivity, is another common symptom. Patients may also experience a reduced range of motion in the spine and, in some instances, a clicking or grinding sensation within the affected joint. The severity of symptoms does not always directly correlate with the degree of degeneration visible on imaging studies.
Diagnostic Procedures
Diagnosing bilateral facet arthrosis combines clinical assessment with imaging and, sometimes, diagnostic injections. A healthcare professional takes a detailed medical history, inquiring about the pain’s nature, duration, and aggravating or relieving factors. A physical examination assesses the spine’s range of motion, identifies areas of tenderness, and evaluates for neurological deficits.
Imaging studies visualize spinal structures and degenerative changes. X-rays reveal bone spurs and joint space narrowing. MRI provides detailed views of soft tissues, including cartilage and nerves, and helps rule out other conditions.
CT scans offer excellent bone detail, showing bone changes and joint enlargement. If imaging is inconclusive, diagnostic injections may be performed. These involve injecting a local anesthetic, often with a steroid, into the facet joint or its nerves. Pain relief after injection confirms the facet joint as the pain source, aiding targeted treatment planning.
Treatment and Management Options
Managing bilateral facet arthrosis typically begins with conservative, non-invasive approaches. Over-the-counter pain relievers, such as NSAIDs, are often the first medication choice to reduce pain and inflammation. Prescription medications, including muscle relaxants or stronger analgesics, may be used for severe pain or spasms.
Physical therapy plays a significant role in conservative management, focusing on exercises to strengthen core muscles, improve posture, and increase spinal flexibility and range of motion. Manual therapy can restore joint mobility. Heat or cold therapy helps manage pain and reduce inflammation. Lifestyle modifications, such as maintaining a healthy weight and ergonomic adjustments, are also recommended.
If conservative measures do not provide sufficient relief, more invasive procedures may be considered. Facet joint injections, delivering corticosteroids and local anesthetic into the joint, offer temporary pain relief by reducing inflammation. Radiofrequency ablation uses heat to temporarily disrupt pain signals from the nerves supplying the facet joints, potentially providing longer-lasting relief.
Surgical intervention for facet arthrosis is generally a last resort, reserved for severe cases where other treatments have failed, or when there is significant neurological compromise or spinal instability. Procedures might involve removing bone spurs or, rarely, spinal fusion to stabilize the affected segment.