Facet Joint Arthritis

 

What are the Facet Joints?

spine bonesThe spine is composed of 33 bones and divided into five sections.  Starting at the neck is the cervical spine.  The Cervical Spine is composed of the 7 neck bones.  Ribs start to attach to the spine below the neck in a 12 bone region called the thoracic spine.  When the ribs end there is a 5 bone section called the lumbar spine that ends when it becomes part of the pelvic girdle.  The spine bones in the pelvic girdle are fused together and called the sacrum, below the sacrum is the tail bones, or coccyx.  The cervical, thoracic, and lumbar spine have two cartilaginous joints between each level on bone that allow for side to side movement and twisting movement.  These joints move the most in the cervical spine, followed by the lumbar spine, and the thoracic spine has the least movement.

What Causes Facet Joint Arthritis?

Facet Joint Arthritis is caused by the breakdown of cartilage in the facet joint.  This is caused by spine degeneration as we age causing the discs to thin or unevenly cushion the spine causing increased pressure on the facets or conditions such as Ankylosing Spondylitis (Bechterew’s disease).  Over time this can wear away at the connective tissue and then the cartilage.  When the cartilage is compromised bone on bone rubbing causes bone to grow, creating bone spurs.  Bone spurs accelerate the rate of cartilage damage; cartilage damage causes more bone spurs.  A feedback loop is created leading to advancing pain in the facet joints.  Diagnostic tools such as a medial branch block may be utilized to confirm the facet joints as the source of pain.  As bone spurs increase in size the nerve innervation in the foraminal canal can become impinged, causing radiating pain, leading to possible surgical intervention.

Treatment for Facet Joint Arthritis

Conservative treatment for Facet Joint Arthritis

Epidural steroid injection facetFacet joint arthritis can be addressed with reducing the inflammation in the facet joints.  Stretching, proper posture and loosing weight can help stabilize the forces on the spine to have a healthy back.  Physical therapy, lifestyle modification, oral, and injectable steroids can all be considered to reduce inflammation.

Surgical intervention for Facet Joint Arthritis

If you are not able to control the symptoms of your facet joint arthritis, then surgical intervention may be considered.  Some patients are candidates for nerve ablation to remove the pain.  Some cases may only get better with a spinal fusion, or possibly a laminectomy if the foraminal canal has become impinged by bone spurs.

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