Cervical Facet Osteoarthropathy: Causes, Symptoms, Treatment, Prognosis, Pathophysiology

The spine is made of vertebrae. Each vertebral level consists of 3 joints. There is a joint between two vertebra which are connected together by an intervertebral disc and two facet joints which connect one vertebra to the other. The facet joints are on the posterior side of the spine, with one located on each side. These three joints together form a tripod. The facet joints are actually synovial joints; they have articular cartilage which covers the ends of the bones, and allows the bone ends to slide over the other. Along with this, every joint has a protective soft tissue called a capsule surrounding it, which is lubricated by a fluid called synovial fluid. The presence of facet joints promotes mobility, stability and restricts excessive motion and ensures that the spine moves with precision.

Arthritis is defined as the degeneration or loss of the articular cartilage in a joint. When there is arthritis of the facet joints of cervical spine, it is called cervical facet osteoarthropathy and leads to pain in the area.

Cervical spine is the neck region of the spine. Arthropathy is a collective term used for diseases of the joints. Thus, cervical facet osteoarthropathy means the diseases of the facet joints in the neck region. It is also referred by the doctors as Cervical Facet Osteoarthritis. The cervical facets carry 30% of the weight of the cervical spine. The facets have larger surface area and also greater weight bearing capacity which makes them prone to greater forces. These forces are capable enough to cause extensive wear and tear and lead to arthritis.

Due to the degeneration of the cartilage in this part of joint, there is inflammation (or arthritis) in cervical region leading to the neck pain and neck stiffness.

The symptoms associated with cervical facet osteoarthropathy are:

• Local neck pain is the most common symptom of cervical facet osteoarthropathy. There is stiffness accompanied with joint clicking or popping noises. This pain then radiates into the shoulders.
• The upper cervical joints can cause local pain along with headaches due to their close proximity to two particular nerves.
• Pinching of the nerve due to spur formation (osteophytes) of the facet bones. There is a specific type of pain caused depending on the level of nerve is involved. The symptoms are manifested in the form of numbness, tingling sensation and pain which radiate down to the shoulders, hands and arms. This further leads to symptoms ranging from clumsiness of the hands to muscle weakness in legs and difficulty in walking.

Most of facet arthropathies improve with use of conservative techniques. The time period of treatment for cervical facet osteoarthropathy can range from 1 to 3 months depending on the severity of symptoms. Further the use of proper posture and body mechanics will allow to maintain a healthy neck and back and provide good prognosis for cervical facet osteoarthropathy. However, once a person starts suffering from a neck problem it remains throughout his life and one can only take measures to prevent it from being injured or damaged.

• Degeneration or general wear and tear of the joint
• Disc degeneration
• Joint stiffness
• Sedentary lifestyle
• Trauma, such as a sudden fall or a motor vehicle accident can also lead to facet joint irritation
• Genetic factors can contribute to the development of degenerative joint disease.

There are seven vertebrae in the neck region. These are connected to each other with the synovial joint called as facet joint. The cartilage in each facet joint in the neck is covered by a capsule which is filled with synovial fluid. This fluid helps to lubricate the facet joints, and enables smooth movements of the joints. This joint stabilizes the spine and allows movement of the neck and back. Over the years due to wear and tear or due to some injury caused by accident, the cartilage wears off and leads to direct bone-bone contact. This causes inflammation which manifests in the form of neck pain and neck stiffness. This damage to the spine in the neck region is called as Cervical Facet Osteoarthropathy.

The wearing of facets in the neck region leads to slipping of one vertebra on the other and increased strain on the disc. This can extend as tear of the disc and starts with the disc degeneration. When there is forward slip of the vertebra, it leads to degenerative spondylolisthesis. This in turn causes neck instability, pain or compression of nerve roots or spinal cord.

The doctor performs physical examination and records medical history. Further imaging techniques are used. X-rays help to determine if there is any joint degeneration or bone malformations. However, they provide limited knowledge. Hence MRI and CT-scans are preferred. MRI helps to know if there is any soft tissue involvement and CT scan gives cross section view of spinal structures by providing 3-D image.

Treatment involves both non-surgical and surgical management of cervical facet osteoarthropathy to reduce pain and increase mobility.

• Non-surgical Methods to Treat Cervical Facet Osteoarthropathy: In case of the mild and moderate symptoms of cervical facet osteoarthropathy, the following conservative steps are followed:
  • Rest when the pain is severe.
  • Application of gels, creams and sprays which relaxes the muscles and reduce acute muscle spasm associated with cervical facet osteoarthropathy.
  • Medication to treat cervical facet osteoarthropathy involve taking of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or COX-2 inhibitors to relieve pain from inflammation.
  • Cortisone injections to reduce inflammation associated with cervical facet osteoarthropathy.
  • Heat or ice treatment to reduce pain associated with cervical facet osteoarthropathy. Patients with neck pain either prefer to use cold pack or heat pack or moist heat wrap for neck to minimize the pain and swelling.
  • Chiropractic adjustments can be done to control chronic symptoms of pain and numbness and provide some relief in case of severe episodes of pain. Similarly, yoga exercises also prove beneficial for cervical facet osteoarthropathy.
  • Physical therapy can be done to reduce inflammation, and help return to full function by restoring joint function, and improving joint motion.
  • Wearing a neck brace to immobilize the cervical spine for a brief period of time may be helpful to manage cervical facet osteoarthropathy. However, it will worsen if worn for long time periods.
  • Some lifestyle changes such as losing weight, stopping smoking and alcohol consumption, eating healthy food and regular exercises help in managing the condition.
• Surgical Method for Treating Cervical Facet Osteoarthropathy: In case of severe symptoms and condition of cervical facet osteoarthropathy which does not respond to the conservative therapy, spine surgery is recommended.

One cannot prevent cervical facet osteoarthropathy since it can be caused due to accidents and excessive wear and tear. Only with some lifestyle modifications, their effects can be reduced. These are:

• Practising good and healthy postures
• No intake of alcohol or smoking
• Practising physical exercises
• Eating a nutritious and healthy diet.

Cervical facet osteoarthropathy is the most common problem. It is generally seen in elderly and is mainly caused due to excessive wear and tear of the facet joints in the neck region. This cannot be totally treated; however one can practise lifestyle changes along with the conservative strategies to reduce the neck pain and discomfort.