Chronic spinal pain often originates from a degenerative process affecting the small, stabilizing joints of the spine. Multilevel facet arthropathy is a specific, chronic form of osteoarthritis where degeneration affects these joints across multiple vertebral segments. This condition can significantly impact mobility and comfort.
Defining Facet Arthropathy and the Multilevel Distinction
Facet joints (zygapophyseal joints) are small, paired synovial joints located at the back of the spine. Each vertebra connects to the adjacent vertebrae via two of these joints, forming a three-joint complex with the intervertebral disc. Lined with articular cartilage and lubricated by synovial fluid, these joints guide motion, prevent excessive rotation, and stabilize the spinal column.
Facet arthropathy is synonymous with spinal osteoarthritis. It occurs when the joint cartilage wears thin and breaks down, causing inflammation and friction. This process leads to the formation of bone spurs (osteophytes) and joint enlargement. These changes restrict smooth joint movement, resulting in pain.
The “multilevel” distinction separates this condition from localized facet degeneration. Multilevel facet arthropathy refers to degenerative changes occurring across three or more adjacent vertebral segments in a spinal region, such as the neck or lower back. For instance, degeneration involving the L3-L4, L4-L5, and L5-S1 joints in the lumbar spine is considered multilevel.
Primary Causes of Joint Degeneration
Facet arthropathy is caused by a combination of mechanical stress and the natural aging process. Decades of constant load-bearing and repetitive movements lead to wear and tear on the joint cartilage. As the cartilage erodes, the joint space narrows, causing friction and initiating an inflammatory response.
Degenerative disc disease significantly accelerates this degeneration. When the intervertebral discs lose height and integrity, the mechanical load shifts backward, placing increased pressure on the facet joints. This altered biomechanics forces the joints to bear weight they were not designed to handle, speeding up deterioration.
Previous acute trauma, such as a spinal injury, can contribute to the earlier onset of facet joint damage. Lifestyle factors like obesity and chronic poor posture also increase mechanical strain on the spine, encouraging the development of arthropathy.
Recognizable Symptoms and Pain Patterns
The pain associated with multilevel facet arthropathy typically presents as a deep, dull ache, localized to the midline of the spine or slightly off-center. This discomfort arises from the inflammation and irritation of the small nerve endings innervating the facet joint capsule. Pain is often worsened by movements that compress the joint, such as extending the back or twisting the torso.
The pain is commonly exacerbated by prolonged periods of standing or inactivity, leading to stiffness upon waking or after sitting. This stiffness usually improves slightly as the person moves and loosens the joints.
While primarily localized to the spine, the pain can follow predictable referral patterns, radiating into the buttocks, groin, or the back of the thigh. This referred pain is distinct from true radiculopathy, which involves nerve root compression causing shooting pain, numbness, or weakness down the leg.
The condition causes difficulty with activities requiring spinal extension, such as standing at a sink or walking for extended periods. As the condition progresses, bone spurs and joint enlargement can lead to spinal stenosis (narrowing of the spinal canal), which may introduce additional symptoms. The chronic pain can also lead to secondary issues like muscle spasms in the surrounding back muscles.
Diagnostic Confirmation and Management Pathways
Diagnosis begins with a detailed medical history and a physical examination focused on identifying pain patterns and functional limitations. The clinician looks for tenderness directly over the facet joints and observes whether motions, particularly extension and rotation, provoke discomfort. Imaging studies are then used to visualize the extent of degenerative changes within the spine.
Standard X-rays may reveal joint space narrowing and osteophytes. A Computed Tomography (CT) scan provides a clearer, cross-sectional view of the bony architecture and joint enlargement. Magnetic Resonance Imaging (MRI) assesses soft tissues, such as intervertebral discs and potential nerve root compression. However, imaging alone cannot definitively confirm the facet joint as the pain source, as many people have asymptomatic degenerative changes.
The gold standard for confirming the facet joint as the pain source involves diagnostic injections called medial branch blocks. This procedure injects a local anesthetic near the medial branch nerves supplying the affected joints, performed under fluoroscopic guidance. A positive diagnosis is confirmed only if the patient experiences a significant (often greater than 80%) temporary reduction in pain immediately following the injection.
Management follows a progressive, stepped-care approach, beginning with conservative, non-surgical treatments. Physical therapy is a primary treatment, focusing on core strengthening and flexibility exercises to improve spinal stability and reduce mechanical stress. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications are often used to manage inflammation and discomfort.
If conservative measures fail, interventional procedures are considered. Therapeutic facet joint injections, containing a corticosteroid and an anesthetic, can be administered into the joint space or around the nerves for longer-lasting relief. For patients who respond well to the diagnostic block, radiofrequency ablation (RFA) offers a longer-term solution. RFA uses heat to temporarily interrupt the medial branch nerve’s ability to transmit pain signals from the joint. Relief from RFA can last from nine months to over a year.