Pain arthritis facet neck joint
The spine is made up of 33 bones called vertebrae stacked one on top of another to form a column. The 7 bones in the neck are known as cervical vertebrae. Between the bones are discs of gristle (cartilage) known as intervertebral discs. The sides of the bones are linked by facet joints. Many ligaments and muscles are attached to the spine and fan out from the neck to the shoulder blades and back. The muscles control movements of your head. The spine protects the spinal cord from outside damage while still allowing you to move your head in any direction. At the level of each disc, nerve roots branch out from the spinal cord, passing through an opening in the side of the spine. The nerve roots in the neck join to form the nerve trunks that run into the arms. Impulses travel along these nerves, sending sensations such as touch and pain to the brain and messages from the brain to the muscles. The vertebral artery carries blood from the heart to the brain. It runs inside the bones of the spine and supplies the part of the brain that controls your balance. Many people develop a stiff and painful neck for no obvious reason. It may happen after sitting in a draught or after a minor twisting injury, for example while gardening. The underlying cause for this type of neck pain is not fully understood, so it is called 'non-specific neck pain'. Having non-specific neck pain does not mean that your neck is damaged and often it happens in people whose necks would appear completely normal under an x-ray. It is the most common type of neck pain and often disappears after a few days. With everyday use over many years the discs and the facet joints become worn. This wear varies from person to person. 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. In a way this is a particular form of osteoarthritis but it is known as 'cervical spondylosis'. These changes may also occur at the bottom of the spine where they are known as 'lumbar spondylosis'. The abnormalities found in cervical and lumbar spondylosis can be seen on x-rays and are present in almost everyone by the age of 65. However, many people have no neck pain even though quite significant changes can be seen on their x-rays. Facet joints, as mentioned above, are small joints behind the discs which help to support the spine and allow it to move. There are 2 facet joints at each horizontal level; one on the right and one on the left of the spine. Facet joint surfaces are lined by 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 receives 2 small nerve branches from the spinal nerves, which send sensory information from the facet joint to the spinal cord and then to the brain. If the facet joint is arthritic or otherwise irritated, the nerves send the information to the brain, which translates the information as "pain". Facet joints are susceptible to trauma and wear-and-tear changes. Trauma to facet joints such as Whiplash injuries, sleeping with a twisted neck, a sudden jerk of the neck, twisting while lifting overhead, or unguarded rotational motion of the spine, may lead to joint capsular tears, irritation of the joint surface, or distortion of the joint alignment. Daily wear-and-tear changes of facet joints can be caused by cartilage loss or spinal disc degeneration. In this case, the height between the vertebrae is diminished as the disc collapses, which results in abnormal loading forces on the facet joint at that level. 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 aggravates the symptoms. Facet syndrome in the lower neck region may manifest itself as pain and tenderness in the neck, shoulder and upper back, loss of cervical spinal curve, and is usually aggravated by neck extension and rotation.
When these changes do cause pain it may come either from the linings of worn joints or from stretched 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 area of the brain that controls balance and this may lead to dizziness. Rarely an extra rib (cervical rib) can cause partial blockage of the blood supply to the arms, resulting in pain and numbness in the hands. Very rarely, in severe spondylosis, the spinal cord can be squeezed, 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), muscle trigger point injections, physical therapy, manipulation, and interventional treatment such as facet joint blocks, dorsal median branch nerve blocks or denervation and prolotherapy. Unfortunately, there has not been a curative treatment for arthritis itself. 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). Before performing denervation, however, a diagnostic facet joint nerve block with local anesthetic must be carried out. By blocking the nerve branches, the brain no longer receives the painful signals from the damaged facet joint and therefore, temporary (2 to 4 hours), pain relief is achieved. As the local anesthetic effect wears off in 2 to 4 hours, the usual pain returns. If the block reduces the pain transiently by at least 50%, the block is considered positive and denervation is usually scheduled. If the blocks reduce the pain less than 50%, most experts consider the results to be "nonspecific" and usually will not proceed with the deadening nerve procedure (denervation). 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 X-Ray guidance. Sensory and motor tests are then performed to insure proper placement of the RF needle on the nerve. Denervation of each nerve is carried out at 80oC for 90 seconds. Complications from the procedure are rare, but most people experience transient local muscle pain and spasm (this may last 2 to 5 days or even longer). The benefit from denervation may last forever (>80% of cases) or 6 to 8 months (< 20%). Denervation may be repeated in 6 to 8 months for those whose nerves regenerate and a similar pain returns. Please see the radiofrequency link for more specific questions and answers. 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. This then results in less pain and greater function. Periodic sacroiliac joint injection with steroids may also significantly reduce chronic sacroiliac joint pain.
|
