What is Facet Joint Disease?

 

Facet disease occurs when there is a degeneration, or breakdown, of the facet joints, which are located between, and behind, your spine’s vertebra. These joints connect the vertebrae together and help control your spine’s motion and flexibility. Because your spine may undergo more than one million twisting and turning motions every year, the joints and their protective cartilage can wear down over time, leading to inflammation, pain and decreased mobility.

 

Although facet disease is most common in the lower back, it may radiate down to the buttocks, hips and back of your upper leg. Facet disease can be tricky to diagnose because it closely mimics the symptoms of a herniated disc, a fracture, or a torn muscle. Possible effects of deteriorating facet joints include:

• Pain in the lower back

• Persistent tenderness around the inflamed joints

• Muscle spasms

• Spinal joint stiffness

• Decreased spinal flexibility

• Discomfort when leaning backwards

Facet Joint Symptoms:

Facet joint deterioration can lead to a number of symptoms in an individual, including back and neck pain and nerve irritation. In a healthy spine, each vertebra includes two pairs of symmetric joint surfaces (a pair on the top and a pair on the bottom) that adjoin the vertebrae together. These synovial joints are coated in a layer of cartilage to facilitate motion and are encapsulated with a thick lubricating liquid called synovial fluid – ensuring the flexibility and extension required from the back and neck. Unfortunately, the facet joints can degenerate due to aging, injury, overuse, and poor body mechanics. These factors can lead to facet joint malfunction and pain.

Symptoms related to facet joint problems are typically localized to the arthritic joint at first. Over time, however, facet joint osteoarthritis can lead to a breakdown in the joint cartilage. Once joint cartilage breaks down, there will be bone-on-bone contact and friction between the facet joints which can lead to the formation of bone spurs. And, if bone spurs grow in an area where they are able to pinch nerve roots or the spinal cord, pain and other symptoms can easily hop on your spine’s nerve highway and travel to the extremities.

Painful facet joint symptoms can originate in the cervical spine (neck), thoracic spine (mid back), and lumbar spine (low back); it all depends on the segment of the spine experiencing an arthritic or damaged facet joint. Symptoms also can include:

• Chronic or acute pain

• Traveling pain along a nerve

• Stiffness or soreness

• Poor posture

• Muscle spasms

Facet Joint Disease Treatment:

 

Facet joint treatment may be necessary when the joints in the spinal vertebrae, called facet joints, become deteriorated to the extent that they are causing back pain or stiffness. Each vertebra has two sets of facet joint surfaces, one set on the top and one set on the bottom, which help connect the spine together and allow a certain degree of flexibility. These joints are coated in cartilage and are encapsulated with a thick synovial fluid to keep the joints mobile. However, like other joints in the body, the facet joints are prone to damage or arthritis as a result of injury or the natural aging process. When this happens, a number of painful symptoms can present and facet joint treatment may become necessary.

Facet joint treatment is usually first attempted conservatively. After identifying the source of the discomfort – usually with medical imagery such as an MRI or CT scan – a doctor will typically begin to manage a patient’s pain with non-surgical techniques. These vary depending on the severity and location of the problematic facet joint, but largely include:

• Physical therapy and exercise

• Prescription or over-the-counter painkillers

• Application of heat packs and cold packs

• Rest

• Chiropractic treatment

• Neck brace, back brace, and/or special pillows

Facet Joint Injections:

 

A facet joint injection can be helpful in relieving pain in a facet joint, and it can also help your doctor to isolate the exact section of the spine that is suffering from the condition. Additionally, if a facet joint injection is successful in relieving your back and neck pain for a few months, this will make it much easier for you to stick to a regimen of conservative, non-invasive physiotherapy.

First, let’s look at what a facet joint injection involves. Once your doctor has isolated the region of the spine that is affected by facet joint degeneration, he or she will administer a local anesthetic to help offset some of the injection pain. Sometimes a sedative IV is administered so that you can fully relax—tenseness can cause an injection to be more painful.

The next step is inserting a needle into the affected facet joint. The needle does need to go through several layers of tissue to reach the joint space, so you may feel some discomfort. Imaging equipment (such as an X-ray) will be standing by as your doctor injects a bit of contrasting dye to verify that the injection is going to the proper place. Next, your doctor will inject a combination of a numbing medication and cortisone into the facet joint. If the numbing medication provides immediate pain relief, then the doctor knows that he or she has found the source of your pain. The entire procedure only takes a few minutes.

You should be able to return to normal activities immediately after your facet joint injection and, although you may feel soreness in your back as the numbing medication wears off, the cortisone should fully mobilize within a few days. It is a long-lasting hormone that releases gradually, which means the pain relief should last for several months.

A facet joint injection to treat facet joint osteoarthritis can be extremely helpful as a form of conservative treatment. Most doctors will advise that other forms of pain relief therapy accompany the injection, such as prescription or over-the-counter pain medication, physical therapy, and rest.