Facet Arthropathy: Causes, Symptoms, Treatment

Facet joints are very important for the back. These joints connect two vertebrae together in the spinal cord. They make the joints flexible and enable the back to move in different directions without any problem. Nerves pass through these joints and many muscles and cartilages are connected with these facet joints; as a whole, the highly functional facet joints are really important for the body and its free movement. Facet joint arthropathy or simply facet arthropathy denotes a degenerative disease that damages the facet joints in the spine and disintegrates the cartilages attached with the joints.

The facet joints nicely connect two consecutive vertebrae to one another, and in this way, all the vertebrae in the back are interlinked with one another. On the other hand, like any other joints facet joints can also become arthritic and painful, it is found through different studies that problematic facet joints are one of the main sources of back pain. The facet joints are positioned at the back of the spine and equipoise the intervertebral discs. Primarily, they help to keep the normal orientation of the spinal column and limit its unnecessary motion that may cause damage to the nerves passing through the spinal cord. When one or more of these facet joints are mildly or severely damaged due to any external or internal reasons, people with this damage face multiple arthritic issues, which is known as facet arthropathy in medical terminology.⁽¹⁾

Following are the primary symptoms of facet arthropathy:

• Mild to severe lower back pain that worsen while standing, bending or twisting is one of the symptoms of facet arthropathy.
• The pain normally remains confined to a specific area.
• In advanced stages, bone spurs grow; from outside, tiny outgrowths or hard projections could be felt.
• As the time passes, spinal stenosis develops, leading to increased back pain, tenderness in the affected area, and weakness in the buttocks and legs.

It is obvious that the primary cause of facet arthropathy is the weakening of facet joints due to any internal and external reasons. Moreover, facet arthropathy can be caused by aging, injury, and overload on the facet joints.⁽¹⁾

Pressure due to overload on the facet joints may be caused by erosion of the intervertebral discs in the spine. As these discs begin to degenerate, they wear away and slowly collapse. As a result, the space between two vertebrae narrows down with time leading to disorientation of facet joints. The obvious result of this situation is too much pressure on the articular cartilage of the facet joints. As the pressure continues, the cartilage begins to wear away. In the next phase, the fluid that surrounds the facet joints begins to reduce in volume. In this condition, mild to high levels of frictions cause bone spurs. When bone spurs grow, they occupy some space in the foramen and space in and press into the nerve roots. As the bone spurs grow further, they force into spinal canal leading to contraction of spinal canal, forming spinal stenosis. During all these stages of damage to the facet joints, the affected person feels pain in the back, which increases over time.

Back pain may occur due to many other problems, so a perfect diagnosis in this disease is necessary for starting the correct treatment procedure. To find out if facet arthropathy is the cause of the complained back pain, the doctor may advise one or more of the following tests:

• A CT scan or MRI, which clearly shows the indication of facet joint degeneration. These examination shows clearly even the mildest problems.⁽¹⁾
• Bone scan is another important examination that shows areas of inflammation in the spine.
• Another diagnosis is done with the help of a diagnostic injection and fluoroscope. In this process, a long needle is used to inject a local anesthetic into the affected area and watches the path of the needle with the help of a fluoroscope. If the pain is relieved, then it confirms the presence of facet arthropathy.

There are several treatment procedures available for treating the pain and symptoms triggered by facet arthropathy:

• Non-Surgical Treatments for Facet Arthropathy: In this treatment procedure, doctors ask the patient to avoid the movements that cause the facet joints to become painful. Such movements include lifting, repetitive twisting, and extending the lower back. At the same time, anti-inflammatory medications are also prescribed. Doctors also ask for certain physical therapy under expert supervision. Physical therapy increases strength of muscles in the lumbar region.
• Injections to Treat Facet Arthropathy: Epidural steroid injections are sometimes used to relieve some pain and uneasiness in facet arthropathy. These injections help to decrease the inflammation that has arisen due to this type of arthritis. However, this is not an everlasting solution, and in most of the cases, the pain may return after some months or even after some days.
• Facet Joint Nerve Ablation for Treating Facet Arthropathy: In some recent treatment procedure, techniques have been developed to lessen the pain by destroying the nerves that are problematic and creating pain and other issues. In this procedure, some tiny electrical probes are inserted into the affected area and an electrical current is sent to destroy the pain creating nerves. This technique is called a sinu-vertebral nerve ablation.
• Back Surgery for Facet Arthropathy: In some situations, doctors decide to go for back surgeries. Surgery may be needed when there is a clear indication of nerve root compression in a facet joint region, or spinal stenosis. Through this kind of surgery, the surgeon eliminates the facet joints between the two vertebrae and seals the gap with the most updated surgical technique. As a result, no more symptoms of facet arthropathy could be found in the same region.

Facet arthropathy may occur at any age, but people above 60 years of age are at higher risk of getting this irritating and painful problem. Too much pressure on the backbone is the primary reason behind its occurrence; however, poor lifestyle, including poor eating habit can also aggravate the problem. Several treatment procedures are available, and the doctors decide on the most suitable one for a patient after diagnosing his or her condition.

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