Facet arthropathy is a common degenerative condition affecting the spine, often recognized as a form of arthritis in the back. The term refers to the deterioration of the small joints connecting the vertebrae, which is a frequent source of chronic back and neck discomfort. This deterioration leads to inflammation and pain signals, affecting mobility and quality of life. Understanding the anatomy of these joints and the factors that contribute to their wear is the first step toward managing this condition.
Understanding the Facet Joints
Facet joints, also known as zygapophyseal joints, are small, stabilizing structures located on the back side of the spine between adjacent vertebrae. They work with the intervertebral discs to form a three-joint complex at each segment. Their primary function is to guide the spine’s motion, allowing for movements like flexion, extension, and rotation.
These specialized joints are covered in smooth articular cartilage and enclosed within a joint capsule lubricated by synovial fluid. The cartilage allows the bony surfaces to glide over one another with minimal friction during movement. This structure limits excessive movement, such as hyper-extension and hyper-rotation, helping to prevent injury to the spinal cord and nerves. The orientation of the facet joints changes slightly throughout the spine, dictating the specific range of motion available in each region.
Factors That Lead to Degeneration
The main reason for the development of facet arthropathy is mechanical stress and age-related wear and tear over a lifetime. As the body ages, the protective layer of cartilage within the joint begins to thin and fray, diminishing its ability to cushion movement. This loss of cushioning causes the exposed bone surfaces to rub against each other, initiating a cycle of friction and inflammation.
The body attempts to stabilize the compromised joint by producing new bone tissue, which results in the formation of bone spurs, or osteophytes. These bony growths further restrict motion and can potentially narrow the space available for nerves exiting the spinal column. Other contributing factors that accelerate this degenerative process include previous spinal trauma, poor posture that places uneven load on the joints, and repetitive stress from heavy lifting or twisting motions. Excess body weight increases the compressive load and strain placed upon the facet joints, particularly in the lower back.
Common Indicators and Symptoms
Facet arthropathy typically involves a distinct pattern of pain and stiffness that varies based on the joint’s location in the spine. A common indicator is localized tenderness directly over the affected joint, often described as a dull ache or deep discomfort. This pain frequently worsens when the patient performs movements that compress the joint, such as bending backward or twisting the trunk.
Conversely, symptoms may lessen when the spine is flexed or bent forward, as this position temporarily reduces the pressure on the facet joints. Stiffness is often noticeable in the morning or after long periods of inactivity, making it difficult to initiate movement. When the arthropathy affects the lower back, the pain may radiate into the buttocks, hips, or the back of the thighs, although it does not typically extend past the knee. If the condition is in the neck, the pain may instead be felt in the head, shoulders, or upper back region.
Options for Managing the Condition
Management of facet arthropathy typically begins with conservative, non-surgical approaches aimed at reducing inflammation and restoring function. Nonsteroidal anti-inflammatory drugs (NSAIDs), available over-the-counter or by prescription, are often used to decrease both the pain and the swelling within the joint capsule. Applying heat or ice to the painful area can also provide temporary relief by relaxing muscles and modulating pain signals.
Physical therapy is a component of long-term management, focusing on strengthening the core muscles that support the spine. A stronger core helps to stabilize the vertebral column, reducing the mechanical stress and excessive movement on the degenerated facet joints. Additionally, maintaining a healthy body weight is an effective strategy to lower the chronic compressive load placed on the joints, particularly in the lumbar spine.
Targeted Medical Interventions
When conservative measures do not provide adequate relief, targeted medical interventions may be introduced to manage the pain directly. Facet joint injections involve delivering a mixture of a local anesthetic and a corticosteroid into the joint to directly reduce inflammation and pain.
Radiofrequency ablation (RFA) is another option. This procedure uses heat to temporarily deactivate the small sensory nerves, called medial branch nerves, that transmit pain signals from the facet joint to the brain. This targeted nerve disruption can provide pain relief that may last for several months or longer.