Facet Arthropathy

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At the back of each spinal segment, a pair of facet joints connect the spine’s vertebral bone. The facet joints of the lumbar (lower back) spine bear a large amount of stress and weight, making them vulnerable to degeneration and injury. These joints are innervated with many spinal nerves, which makes them susceptible to developing pain that is commonly felt in the lower back and / or leg (also known as sciatica).

Facet arthropathy (FA) is a painful, arthritic condition of the spinal joints. These joints allow for bending, twisting, and alignment of the spine. The spinal nerves come off the spinal cord between the vertebra and the facet joints. At the front of the vertebra rests on a spongy contained disc while at the back of each of the two facet joints rests over the facet joint below.

In addition, facet arthropathy is divided into different types depending on the location of the joint. Some types include:

 

  • Lumbar – This is degeneration of the lumbar joints. This is often due to poor body mechanics.

 

  • Cervical facet arthropathy – This means the joints of the neck are experiencing degeneration. Both poor body mechanics and blunt trauma can cause cervical facet arthropathy.

 

  • Thoracic facet arthropathy – The joints in the thoracic area can deteriorate. It causes radiating pain in the arms and chest.

 

  • Bilateral facet arthropathy – This is when degeneration is taking place on both sides of the affected joint.

 

  • Hypertrophic facet arthropathy – Hypertrophy is a term that refers to the increase of an organ or area of the body. In the case of facet arthropathy, it’s the section of the facet joint that is abnormal, causing pain near the specific joint.

 

Facet arthropathy is often associated with chronic lower back pain. Low back pain potential causes include defects of the ligaments that attach the muscles to the spinal discs, compression or pinching of the spinal cord roots, the hard, protective covering of the spinal cord known as the dura, muscle disorders of the lower spine and facet joints.

Causes & Symptoms

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Facet arthropathy can be affected by widespread arthritis of other joints seen in Ankylosing spondylitis, Psoriatic arthritis, and Rheumatoid arthritis. Trauma such as small mis-diagnosed fractures, disc tears, cartilage splitting, or hemorrhage in the area can be some associated findings whilst in the course of facet arthropathy.

Most patients suffering from facet arthropathy tend to experience damaged and dysfunctional spinal discs presenting with facet joint damage at the same level in their spine. Loss of disc height and function places increased stress on the facet joints at that level, which can then cause wear and damage over a period of time.

In severe cases, osteoarthritis can also cause lumbar facet pain. Additionally, the unusual orientation of the facet joints and enlarged ligaments can be associated with facet disease. The synovial capsule may become distended and inflamed which puts pressure on the spinal nerves. When combined with degenerative arthritis and joint instability, pain in facet syndrome results in lower back pain. Rheumatoid arthritis is associated with damage to facets especially the mid-lumbar and lower lumbar areas.

Overall, arthritis in the facet joints can develop from the following:

 

  • Fracture

 

  • A previous lower back injury

 

  • Torn ligaments

 

  • Disc problems

 

  • Wear and tear that decreases space between vertebrae causing facet joints to rub onto each other

 

Due to the additional stress caused by these circumstances affecting the facet joints, bone spurs can also develop and cartilage can deteriorate. Other than due to injuries, facet arthropathy is a condition of aging. Therefore, the main cause of facet arthropathy is spinal degeneration which typically occurs later in life.

Who gets Facet Arthropathy?

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Certain risk factors for facet arthropathy may exist, however, they vary depending on which area of the back is affected. The following factors include:

 

Heredity Risks

Some patients may be prone to developing facet arthropathy due to their genetics or have a family history of the condition. Heredity can play a role in the breakdown or degeneration of discs in the back, which can then lead to facet arthropathy. Other forms of osteoarthritis may occur alongside facet arthropathy. These other types of osteoarthritis, which may affect the hip and knee, are linked to genetics. Therefore, it may be a possibility that facet arthropathy also carries this risk factor.

 

Facet arthropathy in the cervical area

The top of the spine contains the vertebrae of the neck and is known as the cervical area of the spine. Facet arthropathy that affects this area does not appear to have many risk factors. However, no studies have proven that whether strenuous activities (such as lifting or pulling) might cause cervical facet arthropathy.

 

Lower back arthropathy

The lumbar area of the spine is located in the small of the back, where the spine curves in. This area is well-designed to support much of the body’s weight. Facet arthropathy that affects the lumbar area may have several risk factors, such as:

 

  • Gender – Women are more likely than men to develop this condition.

 

  • Age – Lumbar facet arthropathy is much more common in older patients due to the wear and tear of the lumbar area.

 

  • Obesity – People who are overweight may have a higher chance of developing lumbar facet arthropathy (BMI of 30-35 and above)

 

Other risk factors associated with facet arthropathy include overexertion, traumatic injury (due to accidents), and an infection or illness.

How Does it Affect You? How Serious is it?

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Due to facet arthropathy, tiny bony projections and outgrowths called bone spurs may develop. These bony spurs may block the way or constrict the space available for nerve roots, leading to a condition called spinal stenosis. Spinal stenosis results in numbness, pain, and weakness in the legs and buttocks.

Spinal stenosis is often associated with arthritis. Arthritis occurs naturally with age and causes loss of flexibility and elasticity of discs between the vertebrae and loss of ability to absorb shock from physical activities. It results in severe back pain and pain in other body parts.

Recommended Treatment & Rehabilitation

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During a diagnosis in cases of facet arthropathy, this typically includes a detailed medical history, including family history, physical examination, and certain imaging tests. Some of these procedures include:

 

Medical history

A thorough medical history is collected to help determine if the lifestyle changes are responsible for facet arthropathy. Many symptoms of this condition are similar to other spine conditions, therefore, a thorough discussion on presenting signs and symptoms is needed in midst of a diagnosis.

 

Family history 

A detailed family history is taken to check if any predisposing factors are contributing to facet arthropathy.

 

Physical examination

The area at the back, around the neck, and the range of motions in the spine is carefully examined. The patient may be asked to perform certain movements to help locate the pain and tenderness in the spine.

Additional imaging tests include:

 

Bone scan 

The test is performed by injecting radioactive material in the body through veins and it helps to assess bone density and the areas of inflammation in the spine. The damaged portion of bones takes the tracer or dye in a large amount. A special camera is used to look into the bones; the damaged part looks dark in the images.

 

Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans

These tests help to locate the degeneration or damage in the facet joint. The detailed images of the bones are obtained by X-rays and radio waves through the spine.

 

Anti-inflammatory steroid injection

A local anesthetic or steroid injection is administered into the facet joint to confirm the cause of the pain. The injection is used with the aid of X-ray fluoroscopy to ensure the proper placement of the needle in the facet joint.

There are several options for treating the pain and symptoms caused by facet arthropathy, such as:

 

  • Medications – Such as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen are helpful to reduce pain.

 

  • Supportive Brace – While bracing isn’t common in treating benign facet pain, a brace may occasionally be used for non-threatening facet instability, such as a subluxation, to help limit spinal motion and promote healing.

 

  • Stem cell regeneration – Stem cell regeneration is a non-invasive and experimental treatment for damaged and painful facet joints.

 

  • Spine surgery – For patients who have severe back pain due to facet arthropathy, surgery may be an option to relieve the pain of facet arthropathy (in cases of nerve compression, spinal stenosis, spinal instability, and associated motor or sensory symptoms).

 

Almost all treatment programs for facet joint arthropathy involve some type of structured physiotherapy and exercise routine, which is formulated by a physiotherapist with training in musculoskeletal and spinal pain. Physiotherapy typically includes a combination of manual therapy, strengthening, and stretching.

Over time, this treatment is useful in improving and maintaining the stability of the lower back and fostering a healing environment for the tissues. When exercises are performed as directed, long-term pain relief may be supported. Therefore, here are some exercise examples that can help you ease symptoms linked to facet arthropathy:

 

Clamshell

Begin on your left side, knees bent at about a 45-degree with legs stacked on top of one another. Then, keeping your feet together, rotate your right knee towards the sky without rotating your pelvis. Keep your lower leg on the floor. Pause at the top of the motion before slowly returning to the start. Repeat this exercise 12-15 before switching sides each day.

 

Hip flexor stretch

Kneel on your left knee, with your right foot in front. If kneeling is uncomfortable for your knees, kneel on a towel or floor mat. Ensure that your left foot is in line with the left knee. Lean forward into your right knee, while ensuring that your right knee does not go in front of your right ankle. Finally, marginally draw your right hip back and your left hip forward to increase the stretch. Hold this stretch for 30-60 seconds before switching sides twice a day.

 

Cat / Cow exercise

Start on all fours, with your hands under your shoulders and knees under your hips, looking down to keep your neck long. As you exhale, draw your navel in towards your spine and arch your back up towards the ceiling, tucking your chin. Pause for 5 seconds, then, as you inhale, reverse the motion to return to a neutral position. If your body allows for it, lift your tailbone to the sky and lift your neck to look forwards.

 

Foam rolling

This exercise requires a foam roller. Therefore, lie with it perpendicular under your shoulder blades, crossing your arms in front of your chest. Next, lift your hips off of the floor, using your legs and abdominal muscles to roll the foam roller down to your mid-back and up again. Lastly, exhale as you roll down your spine, then repeat 2-3 times a day.

Alternative & Homeopathic Treatment

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Certain alternative treatments are available over-the-counter to help you improve your symptoms either at home or elsewhere. The following treatments include:

 

Heat application

Heat therapy can help relax the muscles and open up blood vessels to allow blood flow and oxygen to reach the painful tissues, providing nourishment. Using a heat patch or hot water bag in the morning after waking may help ease the morning pain and stiffness.

 

Ice application

Cold packs may be used when the pain is acute or during a pain flare-up, such as after strenuous physical activity. A cold pack constricts the blood vessels, reducing blood flow to the region and numbing the pain.

 

Staying active

While avoiding certain activities is recommended, it is also necessary to stay active in moderation and avoid complete bed rest, which may decondition the lumbar tissues and increase the pain.