Does facet arthritis lead to disc problems?
How is facet arthritis diagnosed?
How successful is facet arthritis surgery?
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The facet joints in our spine help to stabilize each vertebra as they connect to the vertebrae above and below. They help to align our spine properly and prevent excessive or abnormal motion in all planes and directions. They are important structures. There are 24 vertebrae and 25 sets of facet joints including the one that connect our spine to the skull (head) and sacrum (pelvis). A spinal motion segment is made up of the vertebrae above and below, the intervertebral disc between them, and two facet joints in the posterior area. It resembles a three legged milk stool. As long as the three legs are equal and attached to the seat, the stool will be balanced, level, and supportive. If one or more legs changes height or loosen, or come apart, there are major support problems and the stool collapses.
The facet joints are true joints containing joint cartilage, a joint capsule, a synovial joint lining, and supporting ligaments. Like other joints in our bodies (fingers, knee, shoulder, hip. Etc.), they are also susceptible to injuries, deformities, arthritis, and fractures. Facet joints have a rich nerve supply that provides our spinal cord and brain with information regarding balance and movement of our spines. They also have tiny nerve endings called nociceptors that are responsible for a specific type of back pain. When the joint capsule is injured or inflamed or swollen, a deep aching type pain is often described. Further, the facet joint can develop bone spurs or osteophytes as well as synovial cysts that act as cushions to prevent arthritic bone from grinding against other structures. These changes in and around the facet joint can also contribute to the formation of spinal stenosis (pinched nerves or spinal cord).
Facet joint conditions are easily imaged using plain X-Rays, CT scans, or MRI scans. Studies such as bone scans and various blood tests are helpful to rule out an aggressive inflammatory problem such as rheumatoid arthritis or ankylosing spondylitis to mention a few. Pain with motion, especially spine extension, is the hallmark of facet induced pain. Careful assessment is required so as not to confuse or miss other causes of back pain such as spinal stenosis or a spine fracture.
Just like all other medical conditions, the key to successful treatment is early diagnosis. With a correct diagnosis, you can be sure that there are no other underlying problems that will cause more serious symptoms in the future. If you have any questions or concerns you would like answered, please feel free to contact Dr. Biscup and he will be happy to answer them for you.
Learn about Facet Arthritis treatment options.
How common is surgery for facet arthritis?
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Some invasive treatments might include radiofrequency ablation, cryotherapy, and laser rhizotomy. The goal of treatment here is to ablate the pain nociceptor nerve endings thereby eliminating the pain in theory. Reports are not conclusive as to any of these modalities and there is an incidence of the pain returning in about 6-8 months when the nerve endings begin to grow back.
Surgery for isolated facet disease is common. There simply is not a consistent and predictable result. Surgery in the form of facet and spinal segment fusion is available and the results have been generally good especially when coupled with a fusion of the disc space using fusion cages and spinal instrumentation. It depends in large part on the underlying condition being treated. Fusing the facet joint alone is possible but not popular with spine surgeons at this time.
