Pain arthritis facet neck joint
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The cervical spine supports the head and also protects the spinal cord.
The spinal cord is the main nerve which runs from the brain, through the neck and down the back.
The spine is made up of a stack of 33 bones called vertebrae. The 7 bones in the neck are known as cervical vertebrae. Between the bones are intervertebral discs. The sides of the bones are linked by facet joints. Ligaments and muscles are attached to the spine and extend out from the neck to the shoulder blades and back. The muscles control movements of your head.
At the level of each disc, nerve roots branch out from the spinal cord, passing through a foramen or opening in the side of the spine. The nerve roots in the neck join to form the nerve trunks that travel into the arms.
The vertebral artery carries blood from the heart to the brain. It runs inside the bones of the cervical spine and supplies the part of the brain that controls your balance.
Over many years the discs and the facet joints become worn. The discs become thinner and this causes the spaces between the vertebrae to become narrower. Also, 'spurs' of bone, known as osteophytes, form at the edges of the vertebrae and the facet joints. This is a form of osteoarthritis called.
Facet joints are small joints located in the rear of each vertebra and they help support the spine and allow movement.
There are 2 facet joints at each level; one on the right and one on the left. Facet joints are lined with cartilage. The facet joint itself is wrapped by a thick fibrous capsule that holds the joint in the proper alignment and gives it strength. Each facet joint has 2 small nerve branches which send sensory information from the facet joint to the brain. If the facet joint is irritated, this leads to the perception of pain.
Facet joints are susceptible to trauma and wear-and-tear. Trauma to facet joints such as whiplash, sleeping in a bizarre position, a sudden jerking of the neck, twisting while lifting
overhead, or rapid rotational motion of the spine, may lead to joint capsular tears, irritation of the joint surface, or abnormalities of joint alignment. Wear and tear of facet joints can be caused by cartilage loss or spinal disc degeneration.
Facet syndrome in the upper neck region may present as headache at the base of the skull, aching behind the eyes, ringing in the ears, and upper neck pain and tenderness. Extension and rotation of the neck usually aggravate the symptoms. Facet syndrome in the lower neck region may present with pain and tenderness in the neck, shoulder and upper back, and loss of normal cervical spinal curvature.
Pain is therefore caused by wear and tear in facet joints or from damage to ligaments. Occasionally, bulging discs or osteophytes pinch the nerve roots and this causes pain or numbness that travels into the arm. If the vertebral artery is pinched, this reduces the blood supply to the part of the brain that controls balance and this may lead to dizziness. In cases of severe spondylosis, the spinal cord can be compressed, which causes weakness and numbness in the arms and legs.
Treatment of facet syndrome includes conservative measures such as local heat, traction, anti-inflamatory medications (NSAIDS), trigger point injections, physical therapy, manipulation, and interventional treatment such as facet joint blocks, dorsal median branch nerve blocks or denervation and prolotherapy.
After failing conventional measures, facet joint injection is usually performed. If the injection produces significant but short term pain relief, denervation of the facet joint can be performed to eliminate the painful sensation from the joints and thus provide long term pain reduction (in 80% of cases).
The denervation procedure is carried out using a radio-frequency (RF) denervation (ablation) technique. A RF needle is inserted and the tip is directed to reach the nerves coming from the facet joints under fluoroscopic guidance.
If denervation only partially reduces the pain, then, the residual pain is usually coming from chronically damaged ligaments/tendons, dysfunctional sacroiliac joints or degenerated discs. Prolotherapy may be a helpful adjunct to therapy by strengthening ligaments/tendons and tightening the loosened or distorted joints.
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