Spine Diseases (Facet Arthropathy)

Facet joints connect the posterior elements of the vertebral body to each other. Facet joints have features similar to joints in other parts of the body. Like the bones forming the other joints of the body, the articular surface of the facet joint is covered with smooth cartilage, surrounded by a capsule made of strong ligaments, and contains synovial fluid that provides lubrication. Like the hip and knee joints, the facet joint can also become arthritic and painful and can cause low back pain. The degeneration of this region of the spine and the pain and discomfort caused by arthritis are called facet arthropathy.

Symptoms

Most people with facet arthropathy complain of pain in the lower back that occurs during rotation and backward bending. Facet arthropathy pain is usually localized to a specific area of the lower back and, unlike the pain and numbness caused by a herniated disc, does not radiate down the leg. However, if arthritis develops in the facet joint, bone spurs (osteophytes) form in the joint, which can compress the nerve roots. This may contribute to the development of a narrow canal, which can cause numbness and pain radiating down the leg and leg weakness.

Diagnosis

Facet arthropathy alone is usually not the sole cause of significant low back pain; it is often accompanied by other conditions such as degenerative disc disease, which contributes to these symptoms, arthritis in other regions of the spine, and frequently a narrow canal. Even in people with mild to moderate lumbar (lower back) spine arthritis, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) show facet joint degeneration findings. Bone scintigraphy showing active inflammation is a test that can be used to determine whether facet arthropathy contributes to low back pain. When a mixture of steroid and local anesthetic is injected into the facet joints and the pain is markedly reduced, and the tests performed (scintigraphy, CT, MRI) show facet joint arthritis findings, a diagnosis of facet arthropathy can be made with reasonable certainty.

Treatment

There are many options for treating the pain and other symptoms caused by facet arthropathy. Initial treatment of facet joint disease includes avoiding movements that cause pain in the facet, using anti-inflammatory medications, and performing stretching and strengthening exercises. Injections can be used to relieve the pain and discomfort caused by inflammation and synovitis in facet arthropathy. Unfortunately, this is not a permanent solution, and the pain may recur after a few months. In a recently developed treatment method called sinu-vertebral nerve ablation, the nerve going to the facet joint is permanently burned with electric current, inserted through the skin with a needle, and pain is reduced. If nerve roots are compressed due to enlargement of the facet joints, or if conditions such as degenerative disc disease, spinal instability, or narrow canal (spinal stenosis) are present, surgical treatment is necessary to relieve the pain.