Pain arthritis facet
The discs are pads that serve as "cushions" between each vertebral body which minimize the impact on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus), which is capable of rupturing (herniating) through the surrounding outer ring (annulus fibrosus) and, thereby, irritating adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues.
When we stand, the lower back is functioning to hold most of the weight of the body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the lumbar structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect, or used in various movements.
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 often quite 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 the nerve roots as they exit the spinal canal. This can be a contributing factor in the development of spinal stenosis, which does cause 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. Pain can be felt in other areas such as the shoulders or midback area. Low back pain is commonly caused 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. The diagnosis is usually made by a physician knowledgeable in spinal disorders like an orthopedic surgeon or pain management specialist. The diagnosis is confirmed by an injection of local anesthetic and an anti-inflammatory medication into the joints that are affected. Relief of pain can be dramatic immediately following this procedure.
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 (CAT scan) or MRI. A bone scan, which shows areas of active inflammation in the spine, is a test that can be used to determine whether or not facet arthropathy may be contributing to a patient's back pain. The facet joints themselves can be selectively injected with a mixture of a local anesthetic and an anti-inflammatory steroid. If this injection relieves a significant amount of the patient's back pain, and there is evidence to suggest that the facet joints are arthritic (such as a positive bone scan, CT, or MRI), then the diagnosis of facet arthropathy can be made with some confidence. There are several options for treating the pain and symptoms caused by facet arthropathy. The initial treatment of facet joint disease involves 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 by quieting down the inflammation and synovitis that is caused by this type of arthritis. Unfortunately, this is often not a permanent solution, and 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 and "feel" the pain of the arthritis. These procedures use small electrical probes that are inserted through the skin into the area of the nerves to the facet joints, and an electrical current that destroys the nerve is sent to the tip of the probe. This procedure is called a sinu-vertebral 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 should be performed by a pain management physician with experience in this type of procedure. There are nerves that arise from the facet joints that carry the painful impulses to the brain. This transmission can be blocked by heating these nerve by radiofrequency waves. The pain relief from this procedure usually lasts around 6 months to 2 years.
In other situations, 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) that need to be treated with surgery. In the course of most forms of a spinal fusion, the surgeon removes the facet joints between the levels of the spine that are to be fused together, which effectively eliminates the facet joints as a source of future symptoms.
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