Multilevel facet arthropathy is a condition where multiple small, paired joints along the back of your spine, called facet joints, experience degeneration. This wear and tear is similar to arthritis. The term “multilevel” indicates that this degeneration affects several levels of the vertebral column, not just a single spinal segment. This condition can lead to discomfort and may affect mobility.
Understanding the Condition
The spine is a complex structure made of bones called vertebrae, stacked one on top of the other, forming a column that extends from the neck to the lower back. Each vertebra connects to the one above and below it through a three-joint complex, which includes a large disc in the front and two facet joints at the back. These facet joints are synovial joints, meaning they are lined with cartilage and lubricated by synovial fluid.
The primary function of these facet joints is to provide stability to the vertebral column while allowing for controlled movement, such as bending, twisting, and extending the spine. Their structure allows for specific ranges of motion in different spinal regions.
Causes and Contributing Factors
Multilevel facet arthropathy primarily develops due to the gradual degeneration of the facet joints, often associated with aging and general wear and tear on the spine. As people get older, the protective cartilage cushioning these joints can thin, and the lubricating synovial fluid may decrease, causing bones to rub together. This friction can lead to inflammation, irritation, and the formation of bone spurs, which are bony overgrowths that can further restrict movement.
Previous spinal injuries, such as accidents or fractures, can also contribute to this condition by damaging the facet joints. Repetitive stress on the spine, poor posture, and excessive body weight can increase the load on these joints, accelerating wear and tear. Other forms of arthritis can also affect the facet joints.
Recognizing the Symptoms
The symptoms of multilevel facet arthropathy can vary but commonly involve pain in the affected areas of the spine, ranging from a dull ache to persistent discomfort. This pain is often localized to the lower back, neck, or mid-back, depending on which spinal levels are involved. Movement often aggravates the pain, particularly when bending backward, twisting, or standing for prolonged periods, while sitting or changing positions may offer some relief.
Along with localized pain, individuals may experience stiffness in the affected spinal region, especially after periods of rest or in the morning. Tenderness may be present when pressure is applied directly over the facet joints. The pain may also radiate to other areas, such as the buttocks, hips, or thighs if the lower back is affected, or into the shoulders and upper back if the neck is involved. Muscle spasms in the surrounding areas are also common.
Diagnosis and Management
Diagnosing multilevel facet arthropathy involves an evaluation by a healthcare provider, beginning with a detailed medical history and a physical examination. During the physical exam, the doctor will assess spinal movement, identify tender areas, and evaluate how different positions affect pain levels. Imaging tests are used to visualize the spinal structures and confirm degenerative changes. X-rays can show bone spurs and narrowing of joint spaces, while magnetic resonance imaging (MRI) and computed tomography (CT) scans provide more detailed views of the joints, cartilage, and surrounding soft tissues, helping to rule out other conditions like herniated discs or nerve compression.
A diagnostic facet joint injection is a specific procedure that can help confirm if the facet joints are the source of pain. This involves injecting a local anesthetic, sometimes combined with a corticosteroid, directly into or near the suspected facet joint under imaging guidance. If the injection provides significant pain relief, it suggests that the injected joint is contributing to the symptoms.
Management of multilevel facet arthropathy often begins with conservative treatments aimed at reducing pain and improving function. Physical therapy is a primary part of this approach, focusing on exercises to strengthen core muscles, improve flexibility, and promote proper posture. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation. Heat or ice application, activity modifications to avoid aggravating movements, and maintaining a healthy body weight are also recommended.
If conservative measures do not provide sufficient relief, interventional procedures may be considered. Facet joint injections can offer temporary pain relief by delivering anti-inflammatory medication directly to the joint. Another procedure is radiofrequency ablation (RFA), where heat generated by radiofrequency waves is used to disrupt the small nerves that transmit pain signals from the facet joints, potentially providing longer-lasting relief. In severe cases, surgical options like spinal fusion may be considered to stabilize the affected spinal segments. The goal of treatment is to alleviate discomfort and enhance a person’s ability to perform daily activities.