Pain arthritis facet spineuniverse
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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Osteoarthritis is a degenerative form of arthritis which can affect the spine.
This condition is also known as “spondylosis.” Spondylosis affects all parts including the intervertebral discs and facet joints.
As people age, biochemical changes occur. In the spine, the structure of the intervertebral discs (anulus fibrosus, lamellae, nucleus pulposus) may be affected. The anulus fibrosus is composed of 60 or more concentric bands of collagen fibers termed lamellae. The nucleus pulposus is a gel-like substance located inside the intervertebral disc and is encased by the anulus fibrosus.
The degenerative effects from aging may weaken the structure of the anulus fibrosus. The water content of the nucleus decreases with age affecting its ability to recover following compression (e.g. shock absorbing quality). Degeneration may decrease disc height and increase the risk for disc herniation.
Each vertebral body has four facet joints. These are the articulating joints of the spine allowing extension, flexion, and rotation. Like other joints, the bony articulating surfaces are covered with cartilage. Cartilage provides a low-friction gliding surface. Facet joint degeneration causes loss of cartilage and formation of osteophytes (e.g. bone spurs).
Osteophytes (e.g. bone spurs) may form adjacent to the end plates of the vertebrae, which may compromise blood supply to the vertebra.
Ligaments connect vertebrae and protect against the extremes of motion (e.g. hyperextension). However, degenerative changes may cause ligaments to lose some of their strength.
Neck pain from spondylosis is common. The pain may spread into the shoulder or down the arm. When a bone spur (osteophyte) causes nerve root compression, extremity (e.g. arm) weakness may result. In rare cases, bone spurs that form at the front of the cervical spine, may cause difficult swallowing (dysphagia).
Pain associated with degenerative disease is often triggered by forward flexion (bending) and hyperextension. In the thoracic spine, disc related pain may be caused by flexion - facet pain by hyperextension.
Spondylosis often affects the lumbar spine in people over the age of 40. Pain and morning stiffness are common complaints. Usually multiple levels are involved (e.g. more than one vertebrae).
The lumbar spine carries most of the body's weight. Movement stimulates pain fibers in the anulus fibrosus and facet joints. Sitting for prolonged periods of time may cause pain and other symptoms due to pressure on the lumbar vertebrae. Repetitive movements such as lifting and bending (e.g. manual labor) may increase pain.
A physical exam will focus on areas of pain as well as range of motion. Neurologic evaluation of sensory and motor function and reflexes are important.
Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.
A CT Scan may reveal bony changes associated with spondylosis. An MRI is capable of revealing disc, ligament, and nerve abnormalities.
Conservative treatment is successful about 75% of the time. Many patients find their pain and other symptoms can be effectively treated without surgery.
Early, anti-inflammatory agents, analgesics, and muscle relaxants may be prescribed for a short period of time. The affected area may be immobilized and/or braced. Soft cervical collars may be used to restrict movement and alleviate pain in the neck.
Lumbosacral orthotics (corsets) may decrease the load on the low back by stabilizing the lumbar spine. In physical therapy, heat, electrical stimulation, and other modalities may be used in the treatment plan to control muscle spasm and pain.
Physical therapy teaches the patient how to strengthen their paravertebral and abdominal muscles (core)to provide support to the spine. Isometric exercises can be helpful when movement is painful or difficult. Exercise helps with strengthening, flexibility, and range of motion.
Lifestyle modification may include an occupational change (e.g. from manual labor), weight loss, and cessation of smoking.
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