Facet joints are indeed one of the crucial joints in the body located at the back of your spine. It helps in maintaining the alignment of vertebral column and restricts its movement beyond the limits of stretching. Facet joints can develop inflammation causing pain and discomfort and sometimes these joints can move from its original place due to degeneration. This can cause facet arthropathy.
Facet arthropathy can cause considerable pain on the lower back and in many cases it can cause disability restricting certain movements. Facet joint problem has become very common nowadays due to sedentary lifestyle and wrong food habits.
There are certain conditions that may present symptoms very similar to that of facet arthropathy. Health conditions like deep infection in the spine, inflammation of cervical facet joint, a fracture and tearing of muscles in the spine can produce intolerable pain and restrict the movements of affected person. And some of the health issues of neck can produce symptoms close to facet joint inflammation. It is very much necessary for the doctor to thoroughly investigate the problem by several tests before deciding on the problem.
Facet Arthropathy Signs and Symptoms :
Intensity of pain on the lumbar and cervical joints varies from one person to the other. Sometimes there can be sharp acute episodes of pain that may last for few minutes. Pain is usually unpredictable which may occur few times or several times a month. The affected facet joints can develop inflammation and becomes tender and many times the person may lose muscle flexibility in the lower back.
There can be discomfort and pain when the person tries to bend forward or lean backward. Back pain may start from the facet joints and proceed downwards till the buttocks region and sometimes even felt on the back of upper leg.
In some cases pain may originate from the facet joint and travel forward affecting the upper back and even the shoulder region. In rare cases pain can be felt till the arm and the person can have restricted muscle movement in the affected hand. Back pain is stable normally and gets intensified when the person attempts to twist the body bending backward or forward.
Sitting for extended hours becomes a major problem for people with facet joint inflammation. It can become very difficult for them to sit and drive a car. Facet arthropathy is marked by bone spurs in the affected region. The bone can outgrow and project outward thereby compressing the neighboring nerve roots causing increased pain. This condition can cause spinal stenosis.
Most of the elderly patients with facet arthropathy are likely to develop degenerative disc disease in which the spinal disc loses its elasticity and flexibility adding more problems.
- It is not known why facet arthropathy occurs in some people and not on others. Some theories suggest that over-stretching of joints can cause this problem.
- High stress factor can also contribute to facet arthropathy when certain chemicals are released into the blood adding more pain.
- People with chronic problems like rheumatoid arthritis and osteoarthritis are at high risk of facet arthropathy.
After carefully completing the physical exam, the doctor may order for series of tests from radiation department. It includes X-ray of spine and CT or MRI scan of the spinal cord. Nature and intensity of the problem can be clearly identified with MRI scanning. Bone spur if any can be detected and treated.
For some people, local anesthesia would be injected on the affected facet joint along with cortisone. If the pain gets relieved immediately the diagnosis is confirmed.
Facet Arthropathy Treatment :
- Proper strengthening exercises combined with drugs can help the patient in overcoming the symptoms.
- The doctor may refer the case to physiotherapist who handles such cases and one needs to follow the exercises and movements given by her.
- Sitting or standing in the right posture is vital for people with facet arthropathy. It is necessary to maintain the normal curvature of the spine to ease off the pain. Cushion support can be had while sitting and driving a car.
- Pelvic floor exercises can help in reducing lower back pain. The patient will be asked to sit in the pelvic tilt posture and the lower pelvic region is rotated forward. The individual will be asked to do some exercises many times a day sitting or standing in the same position.
- Warm compression can help in reducing inflammation and control pain. Hot water bottle or heat wraps can be applied many times to alleviate pain.
- Patients with facet arthropathy should not sit or stand in the same position for long hours. It is essential for them to take regular breaks and make suitable changes in daily routine.
- For people with mild or moderate pain, taking anti inflammatory drugs like Ibuprofen can provide relief. Cox – 2 inhibitors like celebrex can also be taken.
- Mild to moderate type of problems and pain can be managed with physiotherapy and pain killers.
- Tricyclic antidepressants like gabapentin or serotonin reuptake inhibitors are prescribed. To control severe episodes of pain due to facet arthropathy morphine is also given in controlled doses.
- Not all the patients affected with facet joint problem need surgical intervention. Several other approaches like chiropractic and acupuncture can give good relief from pain.
- Wearing neck collar can bring remedy for people with neck problems. They should use soft neck pillow to support the joint and avoid using several pillows which may worsen the pain.
Steroid injections are given in regular intervals to relieve excess of pain and discomfort arising due to facet arthropathy. Inflammation of the joint is considerably reduced by taking a shot of steroid injection. This can provide you pain free weeks and even months. And the injection can be repeated at intervals to get maximum benefit.
Facet rhizotomy is a simple procedure in which small nerve endings instigating pain are frozen and destroyed using the tip of electric rod. It can be performed in office sitting by trained physician. Botox injection can also give relief from pain and muscle spasm.
This is similar to facet rhizotomy procedure that uses electrical probes through the skin which is sent to the nerve endings for destroying its tip. By doing so, the patient will not feel the pain anymore since sensory nerves are destroyed. Mild electric current under control is passed into the nerve ending which is known as facet joint ablation technique.
Back surgery is done when the case is serious and symptoms are not controlled with any of the above methods. Patients with chronic problems like degenerated disk disorder or spinal stenosis are considered for surgery. The surgeon would carefully remove the facet joints that are compressing the nerve root and spinal fusion is done by joining the joints at certain levels. Most of the time pain and discomfort will not occur after successful surgery. The patient should follow the instructions of doctor after back surgery for complete recovery and avoid certain activities.
Recovery from pain caused by facet arthropathy is possible in mild to moderate cases of pain. No preventive measures are available for this disorder. But one can follow healthy lifestyle and eat healthy diet and shed extra pounds to prevent many health problems.
Laminectomy surgery can improve the quality of life for about 70-80% people. They are able to perform daily routine activities after spine fusion. It may take 3-8 months for complete recovery but the success rate is high in surgery.