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Facet Disease

Facet joint disease is a medical disorder that causes discomfort in the facet or zygapophyseal joints of the spine. It becomes more common among adults but can be more severe in the elderly due to changes in the joints that occur with aging.

What is facet disease?

The presence of arthritis or some form of degeneration in the facet joints of the spine is known as facet disease. Facet disease is an inflammatory condition that affects the facet joints and their innervations, causing both local and radiating pain. 

Facet disease affects 55% of cervical vertebrae and 31% of lumbar vertebrae and is a common cause of chronic back pain. 

Cervical facet syndrome refers to neck discomfort caused by cervical facet joint dysfunction, while lumbar facet syndrome refers to low back pain caused by lumbar facet inflammation.

Anatomy of the facet joints

Through each level along the back of the spine, a pair of small facet joints connect the vertebrae, holding the spinal column together. These synovial joints, also known as the zygapophyseal joints, allow the spine to flex and twist in different directions. The articulation of paired bony projections termed articular processes forms a facet joint. These processes join adjacent vertebrae and are found at the rear of each vertebra. Two facet joints and an intervertebral disc are found in each disc space, forming a tripod that provides the motion segment. At each level, the spinal nerves exit immediately above the upper facet.

The articular processes' surfaces are coated with cartilage and encased by a thin, fluid-filled synovial membrane to allow smooth movements and prevent friction. An outer capsule surrounds the facet joint, which is robust, durable, and slightly flexible, and holds joint fluid, which is necessary for lubrication. During spinal motions, a small quantity of fat enters and exits the capsule for further lubrication.

Functions of facet joints

Due to their distinctive structure, the facets allow for spinal movement in a variety of directions, including flexion (forward bending) of nearly 60 degrees. However, extension is limited. The intervertebral discs are protected from rotational injury by the structure and size of these joints, which limit twisting movements.

During motion and rest, the lumbar facets also absorb compressive, and shear stresses applied to the spine. They protect the spine by preventing the vertebrae from moving in ways that could overload and injure the discs, spinal nerve roots, and spinal cord. The nerves that feed blood to the facet joint capsule also help with lumbar proprioception, which is the body's ability to sense its position in space.

Causes of facet disease

The outer capsule covering the facet joint or the joint surfaces of a facet can both cause pain. Degeneration of the spine, commonly known as spondylosis, is the most common cause of facet joint disease.

Spinal Joint degeneration or Spondylosis

Spondylosis is a degenerative disorder that affects the facet joints and the vertebrae of the spine. The disc is usually where the degenerative process begins. Discs can lose water content as they age, causing them to disintegrate or collapse. 

Bone rubbing on bone occurs when the protective cushion between the vertebrae is lost. This might result in excessive wear and strain on nearby spinal structures, which can contribute to the formation of bony spurs (osteophytes). This movement changes the joint's typical mechanics, potentially putting more strain on the facets. As the disease worsens, osteophytes can push their way into the foramina and even the spinal canal, putting pressure on the spinal cord, compressing spinal nerves, and limiting joint movement. The thickening of the spinal ligaments can also be a result of advanced spondylosis, adding to nerve compression and discomfort.

The most critical determinant in the development of spondylosis is age. The spinal discs dry, shrink, develop bone spurs, and show other indications of osteoarthritis as people age. When spinal discs deteriorate, and bone rubs directly against bone, degenerative changes such as bone spurs occur.

Injuries

Breakage or displacement of the facets can occur as a result of acute or recurrent trauma, leading to motion segment instability. Direct trauma, such as car accidents, falls, or sports injuries, is the most common cause of acute facet injury. Work-related actions, such as manual labor that needs bending, twisting, and lifting, or sports injuries, such as gymnastics techniques that require backward bending and twisting, can cause repetitive mild traumas to the facets.

Inflammation of the facet and its surrounding tissues occurs due to these injuries, resulting in back and leg pain (sciatica).

Common injuries that affect facet joints include facet dislocation, articular process fracture, facet capsule strain, and posture-induced injuries.

How facet joint disease leads to pain

Connective tissue and ligaments make up the facet outer capsule. When the ligamentous tissue of the external capsule is overstretched during spinal motions, this capsule may become irritable owing to strain. Damage to the outer capsule can also trigger an inflammatory response, resulting in the production of chemicals that send pain signals to the capsule's nerves.

Pain can also originate from within the facet joint due to Spinal osteoarthritis. Due to bone-on-bone grinding within the joint during movement, natural wear and tear of the facet's cartilage due to aging may cause irritation and stiffness. The surfaces of the facet joints can also be shifted out of place if the spine is moved beyond its normal limits.

Symptoms of facet disease

Symptoms of facet disease will vary depending on the location of the affected joint within the spine. Lower back pain is caused by lumbar facet joint diseases, which are characterized by a localized aching with some stiffness. The discomfort is frequently worse early off in the morning or after a period of inactivity. Radicular leg pain (sciatica) can occur when a spinal nerve root is impinged.

Pain can be localized, referred, or radicular due to the number of facets afflicted, the intensity of the disease, and the risk of a neighboring nerve root being affected.

The lower back is commonly affected by localized pain, which is a dull ache.

The buttocks, hips, thighs, or knees are the most common destinations for referred pain, rarely extending below the knee. Pain in the abdomen and pelvis is also possible. Facet arthritis is the most common cause of this sort of pain, which manifests as a distinct uneasiness with a dull ache. Sharp, shooting pain may spread into the buttock, thigh, leg, and foot if a spinal nerve is inflamed or squeezed at the facet joint.

The discomfort may become more pronounced when the area over the injured facet in the lower back is gently squeezed. If arthritic problems cause the lumbar facet pain, stiffness in the joint may be present. This is usually more noticeable in the mornings or after prolonged rest and is generally reduced once physical activity is resumed. When moving, arthritic alterations in the facets might generate a grinding or grating sensation in the joints.

The discomfort may be confined to one side of the lower back and thigh if a single facet is damaged on one side of the spine. If both aspects of a spinal segment are injured, pain may occur bilaterally.

How to diagnose facet disease

Facet disease is usually identified through an MRI and a physical exam. A doctor's visit is generally the first step in diagnosing facet disorder. Multiple components of a comprehensive exam are likely to be included in the physical examination.

The doctor goes over the patient's significant complaints and inquires about the beginning of pain, the duration and types of signs and symptoms, any coexisting medical illnesses, and the patient's medication and surgical history. The doctor may perform a medical exam to rule out suspected nerve dysfunction that includes gently palpating the back to check for painful places and muscle reflex activity in the legs.

Patients typically experience local pain near the affected joint or joints. Suppose a patient has symptoms of cervical facet disease. In that case, it is common for them to experience pain from the neck and into the surrounding areas where the affected facet joint is located.

How to treat facet disease

Treatment for facet disease depends on the severity of the joint pain being endured. For lots of patients, facet pain can be managed with a facet injection and therapy regimen. This usually helps the pain and discomfort to subside. If patients do not experience any relief from the injections and physical therapy, we recommend a minimally invasive laser procedure known as a rhizotomy. 

Rhizotomy is the destruction of the small nerve to the facet joint. Facet medial branch rhizotomy is the most effective procedure designed to treat this condition and should be combined with therapy to optimize results and durability. Older, more invasive treatments include spinal fusion. This effectively deadens the small nerve that runs to the facet joint.

Our doctors can deaden the pain-causing nerve running through the facet by using a laser and a high-powered endoscope. Following this procedure, there is little to no collateral damage and no hospital stay. Patients treated with a rhizotomy are usually prescribed therapy which allows the patient to quickly recover lost mobility without further joint pain.

Another surgical procedure for curing the effects of facet disease is laminectomy. In facet diseases that lead to spondylolisthesis, a laminectomy procedure involves removing the posterior section of the vertebra (lamina). In this scenario, a vertebra slips over the vertebra below it, potentially compressing spinal nerves and the spinal cord. The space for these neural tissues is restored, and compression is relieved with a laminectomy procedure.

There is always a slight possibility of serious complications, such as infection, excessive bleeding, nerve injury, or severe allergic reaction, with any surgery. It is critical to review the risks associated with each treatment option with the surgeon before deciding on surgery for facet joint pain.

When should I get surgery?

The decision to get surgery is one that is solely left at the discretion of the patient. In the following circumstances, surgery for clinical symptoms caused by facet joint disorders may be proposed:

  • Facets that are severely broken or dislocated and cannot be treated nonsurgically.
  • Symptomatic lumbar/cervical spinal stenosis, lumbar/cervical degenerative disc disease, lumbar/cervical herniated discs, and similar concurrent spinal disorders.
  • The presence of tumors or cysts in the spine.
  • The compression of the spinal nerves that descend from the spinal cord- known as cauda equina syndrome.

Benefits of physical therapy for facet disease

The goal of a physical therapy regimen is typically to reduce painful symptoms, increase body functionality, and maintain good spinal health. Facet joint diseases treatment plans often include structured physical therapy and exercise programs designed by a medical expert with experience in musculoskeletal and spinal pain.

Manual therapy, low-impact aerobic activity, strengthening, and stretching are standard components of physical therapy. This treatment effectively improves and maintains lower back stability throughout time and provides a healing environment for the tissues. 

Recovering patients may achieve long-term pain alleviation if activities are performed as suggested. Physical activity is also required to keep fluids flowing through spinal structures and to minimize swelling that develops naturally in the tissues surrounding an injured joint. This swelling can irritate nerves that are already inflamed as a result of facet joint dysfunction.

Active exercise allows the neurological system to repair and develop stronger in a supervised, non-destructive manner, which is a significant benefit. Active exercise also aids in the creation of physiological conditions that allow injured spine structures to recover.

To learn more about facet disease, watch the video below:

Are you or a loved one experiencing pain from degenerative facet diseases or facet arthritis? Deuk Spine Institute serves the greater Orlando, Titusville, and Melbourne, Florida area and is always accepting new patient inquiries. To learn more, contact us or give us a call at 1-800-FIX-MY-BACK.

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