Pain with motion, especially spine extension, is the hallmark of facet induced pain. Often this is a deep, aching pain – not dissimilar to painful degenerative discs.. Careful assessment helps to avoid misdiagnosis, because the pain may not be from facet arthritis, but from Spinal Stenosis , Degenerative Disc Disease, or a Spine Fracture.
Facet joint conditions are easily imaged using plain x-rays, CT scans or MRI scans. Bone scan studies and various blood tests are helpful to rule out aggressive inflammatory problems, such as rheumatoid arthritis, ankylosing spondylitis and others.
The key to successful treatment of facet arthritis is early diagnosis. A correct diagnosis ensures that no other underlying problems are present to cause more serious symptoms in the future.
The facet joints in our spine help to stabilize each vertebra as they connect to the vertebrae above and below. They are important structures that help to align our spine properly and prevent excessive or abnormal motion in all planes and directions.
Like other joints, facet joints contain cartilage, a joint capsule, a synovial joint lining, and supporting ligaments. Facet joints are susceptible to injuries, deformities, arthritis and fractures.
There are 24 vertebrae and 26 sets of facet joints, including the ones that connect our spine to the skull and to the pelvis (sacrum). 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.
The spinal motion segment resembles a three-legged milk stool. As long as the three legs are equal and attached to the seat, the stool will be balanced and supportive. If one or more legs changes height, loosens or comes apart, the stool will wobble or collapse.
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 capsule of the facet joint in the spine is injured, inflamed or swollen, a deep aching type pain can occur.
The facet joint can develop bone spurs (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).
Learn about Facet Arthritis treatment options.
In theory, the goal of treatment is to ablate, or destroy, the pain nociceptor nerve endings, thereby eliminating the pain. But reports are not conclusive as to the long term benefit of any of these treatments. The pain may often return in six to eight months when the nerve endings begin to grow back.
Surgery for isolated facet disease is not common, and the results are not consistent and predictable. Facet fusion and spinal segment fusion surgery yields generally good results, especially when coupled with a fusion of the disc space using fusion cages and spinal instrumentation.
Results vary, depending in large part on the underlying condition. Fusing the facet joint alone is possible but not popular with spine surgeons at this time.
The following may be employed to treat facet arthritis:
Facet Block and Radio Frequency Nerve Ablation
|Percutaneous Spinal Fusion
Spinal Fusion Without Instrumentation and Implants
Spinal Fusion With Instrumentation and Implants
Laser Facet Ablation