Degenerative facet disease is a condition marked by the breakdown of the facet joints in the spine, leading to discomfort and stiffness. This common age-related ailment involves the gradual wear and tear of these joints, which are vital for spinal flexibility and stability.
Understanding the Facet Joints
Facet joints are small, paired synovial joints located on the posterior side of each vertebra. These joints connect adjacent vertebrae, forming a three-joint complex with the intervertebral disc at each spinal level. They are present in the cervical (neck), thoracic (mid-back), and lumbar (lower back) regions.
Each facet joint is enclosed by a fibrous capsule and contains synovial fluid, which lubricates the joint and minimizes friction during movement. The surfaces where the bones meet are covered with smooth cartilage, allowing the vertebrae to glide. These joints work like hinges, allowing for bending, twisting, and extension of the spine while preventing excessive motion that could harm the spinal cord.
What Causes Degenerative Facet Disease
Degenerative facet disease is primarily a consequence of the natural aging process, as the cartilage within the facet joints undergoes wear and tear from repetitive motions. Over time, this protective cartilage can thin or disappear entirely, causing bones to rub directly against each other. This friction can lead to inflammation, swelling, and the formation of bone spurs, also known as osteophytes, or bony growths along the joint edges.
The condition is also known by several other names, including facet syndrome, spinal osteoarthritis, facet hypertrophy, or facet arthritis. Beyond aging, other factors can contribute to its development, such as traumatic injuries from accidents or sports, causing trauma to the facets. Poor posture, repetitive movements like those in manual labor, and other spinal conditions like disc degeneration or spondylolisthesis (where one vertebra slips forward over another) can place added stress on these joints, accelerating degeneration. Obesity and a sedentary lifestyle can increase the burden on the spine, contributing to joint wear.
Identifying the Symptoms
Symptoms of degenerative facet disease can vary depending on the location of the affected joints within the spine. Individuals experience a dull ache, stiffness, and tenderness in the area of the degenerated joint. Pain often worsens with certain movements, such as extending the spine backward, twisting, or after periods of inactivity.
If the degeneration occurs in the cervical spine (neck), symptoms may include pain at the base of the skull, neck, upper back, and shoulders. Thoracic facet disease is less common but can cause pain in the middle back or just below the shoulders. For issues in the lumbar spine (lower back), which is the most frequently affected region due to bearing the most body weight, pain is felt in the lower back and may radiate to the buttocks, hips, or thighs. Many individuals with degenerative changes in their facet joints may not experience any noticeable symptoms.
Diagnosing and Managing the Condition
Diagnosing degenerative facet disease begins with a thorough physical examination and a review of the patient’s medical history. During the physical exam, a doctor may palpate the spine to identify tender areas and assess range of motion, although physical findings alone cannot definitively confirm the diagnosis. Imaging tests, such as X-rays, CT scans, and MRI, are used to visualize changes in the facet joints, such as cartilage erosion, bone spurs, or joint enlargement.
To confirm a facet joint as the source of pain, diagnostic injections are employed. This involves injecting a local anesthetic directly into or around the suspected facet joint under imaging guidance. If the patient experiences significant pain relief from the injection, it suggests that particular facet joint is the source of discomfort.
Non-Surgical Approaches
Management of degenerative facet disease focuses on non-surgical approaches to alleviate symptoms and improve function. Physical therapy involves exercises to strengthen spinal support muscles, improve flexibility, and correct posture. Medications, including NSAIDs, can reduce inflammation and pain, while muscle relaxants may address spasms. Applying heat or cold therapy to the affected area can provide relief. Lifestyle modifications, such as maintaining a healthy weight, practicing good posture, and engaging in low-impact exercises like swimming or walking, are beneficial for management.
Interventional Procedures
For persistent pain not adequately controlled by conservative measures, interventional procedures like nerve blocks or radiofrequency ablation may be considered.
Surgical Options
In rare and severe cases, such as those with nerve root compression or spinal instability, surgical options like spinal fusion or facetectomy may be explored.