Pain arthritis facet spineuniverse
As people age, biochemical changes occur affecting different tissues in the body. In the spine, the structure of the intervertebral discs (anulus fibrosus, lamellae, nucleus pulposus) may be compromised. The anulus fibrosus (e.g. tire-like) is composed of 60 or more concentric bands of collagen fiber termed lamellae. The nucleus pulposus is a gel-like substance inside the intervertebral disc encased by the anulus fibrosus. Collagen fibers form the nucleus along with water, and proteoglycans. The degenerative effects from aging may weaken the structure of the anulus fibrosus causing the 'tire tread' to wear or tear. The water content of the nucleus decreases with age affecting its ability to rebound following compression (e.g. shock absorbing quality). The structural alterations from degeneration may decrease disc height and increase the risk for disc herniation. The facet joints are also called zygapophyseal joints. Each vertebral body has four facet joints that work like hinges. These are the articulating (moving) joints of the spine enabling extension, flexion, and rotation. Like other joints, the bony articulating surfaces are coated with cartilage. Cartilage is a special type of connective tissue that provides a self-lubricating low-friction gliding surface. Facet joint degeneration causes loss of cartilage and formation of osteophytes (e.g. bone spurs). These changes may cause hypertrophy or osteoarthritis. Osteophytes (e.g. bone spurs) may form adjacent to the end plates, which may compromise blood supply to the vertebra. Further, the end plates may stiffen due to sclerosis; a thickening/hardening of the bone under the end plates. Ligaments are bands of fibrous tissue connecting spinal structures (e.g. vertebrae) and protect against the extremes of motion (e.g. hyperextension). However, degenerative changes may cause ligaments to lose some of their strength. The ligamentum flavum (a primary spinal ligament) may thicken and/or buckle posteriorly (behind) toward the dura mater (a spinal cord membrane). The complexity of the cervical anatomy and its wide range of motion make this spinal segment susceptible to disorders associated with degenerative change. Neck pain from spondylosis is common. The pain may spread (radiate) 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 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. Therefore, when degenerative forces compromise its structural integrity, symptoms including pain may accompany activity. 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 thorough physical examination reveals much about the health and general fitness of the patient. The exam includes a review of the patient's medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include: Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm. Radiographs (x-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but is not as useful as a CT Scan or MRI. The CT Scan may be used to reveal the bony changes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities. Discography seeks to reproduce the patient's symptoms to identify the anatomical source of pain. Facet blocks-trying to relieve pain by injecting anesthetic into the facet joint to determine whether the facet is the source of pain- work in a similar manner. The physician compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. Further, the results from the examination provide a baseline from which the physician can monitor and measure the patient's progress. Conservative treatment is successful about 75% of the time. Many patients find their pain and other symptoms can be effectively treated without surgery. During the acute phase, 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. Physical therapy teaches the patient how to strengthen their paravertebral and abdominal muscles to lend support to the spine. Isometric exercises can be helpful when movement is painful or difficult. Exercise in general helps to build strength, flexibility, and increase range of motion. Lifestyle modification may be necessary. This may include an occupational change (e.g. from manual labor), losing weight, and quitting smoking. If there is neurologic deficit, certain surgical procedures may be considered. However, before surgery is recommended, the patient's age, lifestyle, occupation, and number of vertebral levels involved are carefully evaluated. If a patient requires surgery, then they should realize that the post-surgical phase is extremely important. Always follow the instructions provided by the physician and/or physical therapist. This includes: Take medication as directed. Report side effects to your physician immediately.
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