What are Facet Joints?

Facet joints are found in the posterior of the spine. There are 24 vertebrae which form the human spine. There are two facet joints between the vertebrae of each spinal segment along the spinal column.

The facet joints and disc space form a three joint complex near each vertebra. A facet joint has two bony surfaces with cartilage between them and a capsule of ligaments surrounding it. Synovial fluid lubricates the joints as is the case with any joint.

What is Facet Arthropathy?
Simply put, the facet arthropathy is degenerative arthritis affecting the facet joints in the spine. In the area of the spine where there are facet joints, arthritis pain can develop.

What Can Cause Facet Arthropahy?
Arthritis in the facet joints can develop from:

Wear and tear (decreases space between vertebrae causing facet joints to rub together)

Previous back injury

Fractures

Torn ligaments

Disc problems

Due to additional stress caused by these circumstances on the facet joints, bone spurs can develop and cartilage can deteriorate.

Who Can Develop Facet Arthropathy?
Other than the aforementioned injuries, facet arthropathy is a condition of aging. The primary cause of facet arthropathy is spinal degeneration which typically occurs in later life.

What are the Symptoms of Facet Arthropathy?
Pain is the main symptom associated with facet arthropathy. The pain is typically worse following sleep or rest. Pain associated with facet arthropathy may be exacerbated by twisting or bending backwards. Low back pain is the most frequent complaint but it does not typically radiate down the legs or buttock, unless spinal stenosis also is involved.

How is Facet Arthropathy Diagnosed?
X-rays, CAT scans, and Magnetic Resonance Imaging (MRI) may be used to help diagnose facet arthropathy. However, x-rays, CT scan and MRI cannot tell whether a facet joint is painful or not. The best way to diagnose whether the joint is painful is to perform a diagnostic procedure. This involves placing the needle next to the nerve that goes into the joint. By placing a small amount of anesthetic on the nerve, the joint is anesthetized for three or four hours, similar to having a tooth numbed in the dentist's office. If the patient experiences significant decrease in pain for several hours after the injection, then one can assume that the facet's are a significant source of the pain and that treating the joints may lead to significant, long-term pain relief.

How is Facet Arthropathy Treated Conservatively?
Initially the doctor may recommend a period of rest in an effort to tame the symptoms. Sleep positions which take pressure off facet joints may be recommended (i.e. curl up to sleep or lay on back with knees up and pillow underneath).

Some oral medication may be prescribed including:

Tylenol

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Muscle relaxants

Corticosteroids

Other treatment options include:

Traction

Strengthening and aerobic exercise

Water therapy

Spinal manipulation

What other Treatments May Help Facet Arthropathy?
If conservative management does not provide adequate of long-term pain relief and the patient responds to the diagnostic facet injections described above, then a technique called radiofrequency median branch neurotomy (rhizotomy) can be performed. This involves placing the needle next to the nerve that goes into the joint. The needle heats up the tissue immediately next to its tip, causing a local burn effect. In essence, it cuts a small portion of the nerve. This is not a permanent injury to the nerve in that the nerve will regenerate itself over the next several months to a year, year and a half. However, during this time, appropriately selected patients can experience significant, long-term pain relief after the procedure. Properly performed, there are minimal side effects or complications. The most common problem is neuritis (less than 5% of patients) which presents as a burning sensation in the back for four or five weeks after the procedure. This can generally be controlled either with medication or steroid injections. Median Branch Neurotomy