Facet Joint Arthropathy – What is it and how is it treated?

At a Glance:

What is a facet joint?

The spine consists of a column of portable bones (vertebrae) that are linked to one another through a joint called facet joint. Facet joints are found in three regions of the spine, i.e., the neck region (cervical spine), middle of the back (thoracic region) and the lower back (lumbar spine). The facet joint is present in two sets, one is the superior articular facet that faces upward, and the other is the inferior articular facet that faces downward. These joints are coated with lubricating fluid (synovial fluid) and smooth cartilage that permits even and trouble-free movement of the joints.

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What is facet joint arthropathy?

Facet joint arthropathy occurs as a result of degeneration of the joints that hold vertebrae together or the wear and tear of cartilages present between the joints. As a result, the motion in the vertebral bones is restricted, which causes pain, swelling and stiffness.

Overtime, ageing causes the disintegration and wearing down of facet joints. The facet joint’s cartilage wears down to such an extent that no lubricating fluid is left and the bony surfaces in the joints strike against each other. This friction between bones can cause intense pain, stiffness and limited movement of the joints.  Small bone spurs also form due to rubbing of the bones that constricts the spinal cord and the spinal nerve roots, leading to pain, numbness and muscle spasms.

What are the symptoms of facet joint arthropathy?

The symptoms of facet joint arthropathy usually develop when the joints in the spine become swollen, restricting the mobility of the spine. Pain is the most common symptom, especially, lower back pain that deteriorates with standing, twisting and bending backwards. The back pain is usually intermittent and occurs several times in a month or year. There could be pinpoint tenderness depending upon the vertebra affected. Over time, with the continuous wear and tear, the entire joint cartilage collapses, worsening the condition.

In addition to the pain, the patient with facet joint arthropathy may experience the following signs and symptoms:

• Stiffness and soreness
• Muscle spasms
• Poor posture
• Tenderness
• Limited range of motion
• Radiating pain along the nerve to the legs and buttocks, but seldom to the foot or below the knee
• A feeling of bone rubbing against another bone
• Formation of small bony spurs

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What are the causes of facet joint arthropathy?

As we get older, the cartilages between the facet joints wear down and get damaged. A repetitive movement, an injury, obesity and other spine conditions can change the alignment of the facet joints, and contribute to its degeneration. Other causes include:

• Osteoarthritis: It involves disintegration of the joint cartilage and the underlying bone. Osteoarthritis of the facet joints is common in the middle-aged people.
• Posture: The wear and tear of the cartilage between the facet joints may occur due to improper posture and heavy lifting.
• Accidents and injuries: A sports injury, car accident, and a sudden fall can cause injury to the facet joints leading to facet arthropathy.
• Synovial cyst: A fluid-filled sac (cyst) may form in the spine because of ageing, resulting in facet arthropathy.

Who is at risk of facet joint arthropathy?

Following are the factors that may contribute to the development of facet joint arthropathy:

• Age (older people): It is commonly found between the ages 40s and 70s
• Obesity (BMI of 30-35 and above)
• Genetics (heredity)
• Gender (common in women)
• Overexertion
• Traumatic injury (due to accidents)
• Infection or illness

What are the complications if facet joint arthropathy is not treated?

Due to facet arthropathy, tiny bony projections and outgrowths called bone spurs may develop. These bone spurs may block the way or constrict the space available for nerve roots, leading to a condition called spinal stenosis. Spinal stenosis results in numbness, pain, and weakness in the legs and buttocks.

Spinal stenosis is often associated with arthritis. Arthritis occurs naturally with age, and causes loss of flexibility and elasticity of discs between the vertebrae, and loss of ability to absorb shock from physical activities. It results in severe back pain and pain in other body parts.

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How to diagnose facet joint arthropathy?

The diagnostic work-up usually includes a detailed medical history, including family history, thorough physical examination and certain imaging tests. Some of the diagnostic procedures include:

• Medical history: A thorough medical history is collected to determine if the lifestyle changes are responsible for the current condition. Many symptoms of facet joint arthropathy are similar to other spine conditions, therefore a thorough discussion on presenting signs and symptoms is needed to arrive on a diagnosis.
• Family history: A detailed family history is taken to check if any predisposing factors are contributing to the condition.
• Physical exam: The area at the back, around the neck and the range of motions in the spine is carefully examined. The patient may be asked to perform certain movements to help locate the pain and tenderness in the spine.

• Imaging tests:
  • CT scan or MRI scan: These tests help to locate the degeneration or damage in the facet joint. The detailed images of the bones are obtained by passing the strong beam of light, such as X-rays and radio waves through the spine.
  • Bone scan: The test is performed by injecting radioactive material (tracer or dye) in the body through veins and it helps to assess bone density and the areas of inflammation in the spine. The damaged portion of bones takes the tracer or dye in large amount. A special camera is used to look into the bones; the damaged part looks dark in the images.
  • X-rays: A beam of x-rays is passed through the body, penetrating through the bones. The test can help detect the spine condition or any damage to it.
  • Anti-inflammatory steroid injection: A local anesthetic or steroid injection is administered into the facet joint to confirm the cause of the pain. The injection is administered with the aid of x-ray fluoroscopy to ensure the proper placement of the needle in the facet joint. The intensity of pain is estimated before the injection and 20-30 minutes after the injection and over the next week. If the pain intensity is decreased by 75%, then the cause of pain is confirmed to be facet joint arthropathy.

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What are the treatment options for facet joint arthropathy?

Treatment for facet arthropathy includes medications, surgery, physical therapy, and self-care. The treatment mainly focuses on relieving pain and stiffness, and making a person active.

• Self-care: Motions or movements that cause pain, such as repeated twisting, lifting, and extending the lower back should be avoided.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These medications help to relieve pain and inflammation. The examples include aspirin, ibuprofen and naproxen.
• Anesthetic injections: Pain relievers, corticosteroids or anesthetics, can be injected into the spine to relieve pain, and inflammation and cause numbness in the painful joint.
• Physical therapy: A physical therapist can instruct some physical activities, such as walking techniques, proper lifting, exercise to strengthen the lower back and stomach muscles and some stretching exercises. This therapy can help in regaining strength and movement in the spine.
• Nerve radiofrequency ablation: In this procedure, radiofrequency waves are used to shut down a nerve in the affected facet joint, to stop the pain signals from passing to the brain. This procedure gives long-lasting relief from pain, i.e., from 9 months to 2 years or more.
• Spinal fusion surgery: During this procedure, the affected spinal bones are fused together into one bone that limits its movement, thereby, alleviating pain and avoiding friction between damaged bones in the spine.

How can one prevent facet joint arthropathy?

Facet joint arthropathy cannot be prevented, but there are certain measures that can decrease the risk of developing it. These include:

• Maintaining a healthy body weight
• Exercising regularly
• Maintaining good posture (sitting, walking and standing)
• Avoiding injuries (while playing sports and other activities)
• Quitting smoking
• Eating a well-balanced diet
• Taking vitamin and calcium supplements for healthy bones

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What to expect once you are diagnosed with facet joint arthropathy?

Unfortunately, the damage to the facet joints cannot be reversed, and the symptoms aggravate in due course. Back pain can be troublesome and debilitating, but newer medications and other physical therapy modalities can help manage the pain effectively. Complying with the treatment plan can significantly improve the facet arthropathy symptoms and increase the possibility of leading an active and healthier life.

About Author –

Dr. Ravi Suman Reddy, Senior Neuro & Spine surgeon, Yashoda Hospitals – Somajiguda

MCH (NIMHANS), Advanced training in Stereotactic Radiosurgery (Brain Lab Academy – Germany). His expertise includes frameless stereotactic neurosurgery, minimally invasive spine surgery, spine stabilization, nerve radiofrequency ablation, cranial micro neurosurgery, cranio-spinal trauma, and endoscopic surgery.