Pain arthritis facet
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 lumbar spine consists of a stack of vertebrae whose function is to provide a movable support structure while also protecting the spinal cord from injury.
Each vertebra has a spinous process, a bony prominence posterior to the spinal cord. The vertebrae also have a strong bone in front of the spinal cord to aid with weight-bearing as well as protection of the spinal cord.
The posterior part of the vertebra also contains facet joints- one on each side- that allow the vertebrae to interact. The facet joints connect the posterior elements of the vertebral bodies to one another. The articular surfaces of the facet joints are covered by a layer of smooth cartilage, surrounded by a strong capsule of ligaments, and lubricated by synovial fluid. Just like the hip and the knee, the facet joints can also become arthritic and painful, and they can be a source of back pain. The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthropathy, which simply means a disease or abnormality of the facet joints.
The discs are cushions between each vertebral body which minimize the impact on the spine. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus), which is surrounded by a tougher fibrous outer ring (annulus fibrosus).
Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach to each of the vertebrae and surround each of the discs.
The lower back functions as support with standing and helps with movements such as extending or rotating at the waist.
Most people who have facet arthropathy will complain of low back pain that is worse with twisting or extension (bending backwards) of the lumbar spine. The pain is usually well localized, and unlike the pain and numbness caused by a herniated disc or sciatica, it does not usually radiate into the buttocks or down the legs.
However, as the facet joints become arthritic, they often develop bone spurs that can decrease the amount of space available for nerve roots as they exit the spinal canal.
This can contribute to the development of spinal stenosis, which causes pain, numbness, and weakness in the buttocks and legs. People who suffer from this problem usually complain that they have to turn their entire body to look over to the right or left.
Low back pain as a result of facet joint arthritis is commonly called by facet joint syndrome. Pain is felt in the lower back and sometimes it can be felt in the buttock as well in the thighs usually not going below the knee. Inflammation of these joints can cause stiffness and difficulty standing up straight and getting up out of a chair.
People who suffer from this problem typically complain that they walk in a hunched over position.
Facet arthritis is rarely the only cause of significant back low back pain, and patients who have this condition often have other disorders that may be contributing to their symptoms, including degenerative disc disease, arthritis of other parts of the spine, and often spinal stenosis as well.
Most people with even mild to moderate amounts of arthritis of the lumbar spine will have evidence of facet joint degeneration on a CT scan or MRI.
The facet joints can be selectively injected with a mixture of a local anesthetic and an anti-inflammatory steroid. If this injection relieves the patient's back pain, and there is evidence to suggest that the facet joints are arthritic, then the diagnosis of facet arthropathy can be made with some confidence.
The initial treatment of facet joint disease includes avoiding the motions that cause the joints to be painful (such as repetitive twisting, lifting, or extension of the lumbar spine), a course of anti-inflammatory medications, and stretching and strengthening exercises to improve the strength and endurance of the muscles in the lumbar spine. Injections can be used to relieve some of the pain and discomfort of facet arthropathy.
Unfortunately, the pain may recur after several months. There are a few techniques that have recently been developed that attempt to alleviate the pain of facet arthropathy by permanently destroying the nerves that innervate the facet joints. These procedures use small electrical probes that are inserted through the skin into the area near the nerves to the facet joints, and an electrical current destroys the nerve. This procedure is called a nerve ablation. For chronic cases of facet joint syndrome, where the pain relief from the injections is short lived a procedure called radiofrequency rhizotomy can be performed. This procedure is performed by a pain management physician. The pain relief from this procedure usually lasts around 6 months to 2 years.
Surgery may be indicated to relieve the pain of facet arthropathy. This usually occurs when there is evidence of nerve root compression from enlargement of the facet joints, or other disorders in the lumbar spine (such as degenerative disc disease, spinal instability, or spinal stenosis).
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