FACET ARTHRITIS

 

What is Facet Arthritis?

Most people suffer from an aching back at some point in their lives. This mainly occurs when the cartilage that covers the ends of the joints wears out and degenerates. When this degenerative change involves the facet joint, facet arthritis occurs. This condition gradually develops pain and stiffness and leads to a chronic situation (Evans & Evans, 1982). Facet joints in the spine usually located in the back (posterior) aspect of the spine. Facet joints at each vertebral level typically found one on each side of the spine. These joints allow flexibility and stability of the vertebral column.

The medical term “Facet Arthritis” refers to a condition that makes degenerative changes of the joints by affecting the structures in the anterior aspect of the vertebral column. This condition favors the growth of bone spurs and enlargement of the joints (hypertrophy) (Kalichman & Hunter, 2007). Ultimately, this causes a completed functional failure of a synovial facet joint. Patients with facet arthritis face difficulties while allowing their spine to turn or bend with movement. In facet arthritis, the cartilage surroundings the joint become thin and dwindles. Facet arthritis of the spine involves inflammation of the spine’s joints, more specifically facet joints, a breakdown of the cartilage in the facet joints, and changes in the spinal vertebrae by developing osteophytes.

What are the Common Symptoms and Causes of Facet Arthritis?

The most common symptoms of facet arthritis include severe pain and stiffness of the joints in the neck and lower back. These symptoms may come and go for a long time. Sometimes, the pain may radiate towards the surrounding areas and cause severe headaches because of arthritis in the neck. Facet arthritis in the lower back results in tingling in the foot. The severity of symptoms depends upon the number of facets joint affected and the involvement of the spinal nerve root. The symptoms of facet arthritis may include (Kalichman et al., 2008):

  • Pain radiates towards the ear, back of the head, and shoulder due to the degeneration of the cervical facet joint.
  • Radiating pain towards the foot and lower back region such as button, hip, thigh, knee, etc. because of the degeneration of the lumbar facet joints.
  • Tingling in the foot, limb, and back.
  • Sometimes, cervical pain may transfer to the occipital area, shoulder girdle, and posterior scapular region.

Several factors contribute to the development of facet arthritis. The most common factors associated with the degenerative changes of joints include aging and instability of the spine. Associated risk factors of facet arthritis include age, sex, history of trauma or fracture, poor posture, overweight, degenerative disc disease, and family history of degenerative arthritis. This condition mainly occurs because of poor posture and physical trauma or injury.

Facet arthritis usually occurs very slowly, usually taking several years. Researchers found a proven relationship between age and the prevalence of facet arthritis. A study found almost 15 to 45% of patients with lumbar facet joints as a common source of pain (Tiwari et al., 2020). Also, almost 35 to 42% of patients with neck pain share a common cause of facet arthritis. People ages between 40 to 70 become more susceptible to facet arthritis (Tiwari et al., 2020).

How do Spinal Specialists Diagnose Facet Arthritis?

Initial diagnosis of facet arthritis involves a brief medical history of patients and performing some physical examination (clinical presentation and pain pattern of patients) to identify the potential source of pain. Physicians may perform some additional imaging tests like X-rays, CT scans, and MRI of the spine to show changes with facet arthritis. Some other tests may include (Thipse, Anap, Shete, & Diwate, 2014):

  • Single-photon emission computed tomography (SPECT)
  • Kemp test

Kemp test helps to assess lumbar spine facet joint pain. This test uses the patient’s trunk both as a lever to induce tension and as a compressive force. A true positive test produces numbness or tingling radiating to the legs. Sometimes, doctors inject a diagnostic (anesthetic) injection into the facet joint to get valuable diagnostic information about the potential cause of pain.

How do Neurosurgeons Treat Facet Arthritis?

Doctors primarily treat facet arthritis with conservative non-surgical procedures. These include (Kalichman & Hunter, 2007):

  • Complete rest: Resting and reducing the use of the spine may help to ease symptoms sometimes.
  • Medications: First-line therapy includes the application of pain-relievers like aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and anti-depressants.
  • Hot and Cold fomentation: This topical therapy helps to reduce pain and prevent muscle soreness.
  • Muscle relaxers: This helps to calm muscles and ease pain and tightness.
  • Physical therapy: This includes posture correction, stretching, and strengthening of the abdominal and lower back muscles to increase back and stomach muscles.

Sometimes, neurosurgeons inject corticosteroids, platelet-rich plasma (PRP) or bone marrow concentrate, or radiofrequency ablation when conservative treatment did not respond well. Doctors also use fluoroscopy in facet block used to treat pain.

Sometimes, neurosurgeons suggest surgical intervention for a long-standing case. This complication occurs when facet arthritis links with spinal stenosis or herniated discs and produces unbearable pain and loss of motor function. In case of any emergency, please contact with our neurosurgeon in the hospital.

If You are experiencing Facet Arthritis in the Fort Worth Area, Contact Longhorn Brain & Spine Immediately To Get a Consultation.

References

Evans, D. P., & Evans, D. P. (1982). Osteoarthritis of the facet joints. Backache: Its Evolution and Conservative Treatment, 9(4), 157–159. https://doi.org/10.1007/978-94-011-6672-0_14

Kalichman, L., & Hunter, D. J. (2007). Lumbar Facet Joint Osteoarthritis: A Review. Seminars in Arthritis and Rheumatism, 37(2), 69–80. https://doi.org/10.1016/j.semarthrit.2007.01.007

Kalichman, L., Li, L., Kim, D. H., Guermazi, A., Berkin, V., O’Donnell, C. J., … Hunter, D. J. (2008). Facet joint osteoarthritis and low back pain in the community-based population. Spine, 33(23), 2560–2565. https://doi.org/10.1097/BRS.0b013e318184ef95

Thipse, J., Anap, D., Shete, D., & Diwate, A. (2014). Prevalence of chronic facet arthropathy: a retrospective study. International Journal of Research in Medical Sciences, 2(1), 193. https://doi.org/10.5455/2320-6012.ijrms20140237

Tiwari, P., Kaur, H., Kaur, H., Jha, V., Singh, N., & Ashraf, A. (2020). Prevalence of facet joint arthritis and its association with spinal pain in mountain population-A cross-sectional study. Journal of Craniovertebral Junction and Spine, 11(1), 36–45. https://doi.org/10.4103/jcvjs.JCVJS_121_19