What Is Facet Arthropathy?

Facet arthropathy, also known as facet osteoarthritis, is a type of wear-and-tear arthritis affecting the spine. It affects the bony protrusions, called facet joints, that connect the bones of the spine. Symptoms include neck and back pain which can get worse with standing, twisting, or bending.

Facet arthropathy is diagnosed using X-rays or other imaging studies. Treatment includes over-the-counter pain relievers, prescription muscle relaxers, exercise, and spinal manipulation. Severe cases may require surgery.

This article explains what facet joints are and how they develop osteoarthritis. It also describes the symptoms, diagnosis, and treatment of facet arthropathy.

What Are Facet Joints?

Facet joints are found along the back of the spine. They help maintain the alignment of the spinal bones (vertebrae) and limit excessive motion. There are 24 vertebrae that form the spine, with two facet joints between each.

The facet joints, along with a cushioning pad called an intervertebral disc, form a three-joint complex between each vertebra. Synovial fluid lubricates the joints so they can move easily.

Facet Arthropathy Symptoms

Pain is the main symptom of facet arthropathy. The pain is typically worse in the morning when awakening and later in the evening, The pain can also get worse when twisting or bending backward. Bending forward often relieves the pain.

The symptoms can vary based on the part of the spine that is affected. Lower (lumbar) back pain is the most common complaint and often causes:

• Dull or aching pain on both sides of the spine
• Radiating pain to the buttocks and legs
• Clicking sounds or "catching" sensations when moving the spine
• Pins-and-needles sensations in the hands or feet
• Muscle spasms or cramps
• Muscle weakness

What Causes Facet Arthropathy?

Facet arthropathy is a type of degenerative arthritis that causes progressive damage to the spine. Spinal osteoarthritis (also known as spondylosis) is the most common cause, but it can occur with a severe form of spinal arthritis known as ankylosing spondylitis.

Arthritis in the facet joints can develop due to:

• Aging-related wear and tear
• A previous back injury
• Spinal fractures
• Torn ligaments
• Disc problems

The deterioration of facet joints can also cause bony overgrowths called osteophytes (bone spurs). These can cause radiating pain and restrict the range of motion of the spine.

Diagnosis of Facet Arthropathy

Imaging studies are central to the diagnosis of facet arthropathy. There are several types that not only confirm the diagnosis but also characterize the nature and severity of your condition:

• X-ray, which provides a plain black-and-white image of the spinal column
• Computed tomography (CT), which composites multiple X-rays to create a three-dimensional image of the spinal column
• Magnetic resonance imaging (MRI), which uses powerful magnetic and radio waves to visualize soft tissues such as ligaments and cartilage

The diagnosis can be confirmed with a diagnostic block. This involves the injection of a small amount of local anesthetic into a facet joint. The placement of the needle is directed either with an ultrasound or a CT scan. Facet arthroplasty is confirmed if the injection is able to provide immediate relief.

Your healthcare provider may also want to exclude other possible causes as part of the differential diagnosis. This includes conditions that mimic facet arthropathy, such as:

• Herniated disc
• Rheumatoid arthritis
• Psoriatic arthritis
• Reactive arthritis
• Spinal gout

Treatment of Facet Arthropathy

The treatment of facet arthropathy varies based on its location and severity. As a general rule, conservative treatments are used before more invasive procedures are considered.

Lifestyle Changes

Initially, your healthcare provider may recommend a period of rest and the avoidance of aggravating movements, including any activity that involves bending or twisting. Activities that take the weight off the facet joint, such as sitting, leaning forward, or changing positions may help ease the pain.

You may also be advised to adjust your sleep positions to take the pressure off facet joints. Options included curling up on your side or lying on your back with your knees propped up with pillows.

Medications

If a diagnostic block was used, you may not need any immediate pain medications. But as the anesthetic starts to wear off, you may be prescribed over-the-counter or prescription pain relievers based on the severity of your pain.

Options include:

• Analgesics like Tylenol (acetaminophen)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen)
• Muscle relaxants like Lloresal (baclofen) for acute back pain
• Antidepressants like Cymbalta (duloxetine) for chronic back pain

Physical Therapy and Exercise

Physical therapy is a cornerstone of the treatment of lower back pain. The treatment plan should include exercises tailored to strengthen the core muscles and avoid stress on the spine.

Examples include:

• Mechanical traction to help decompress the spine
• Knee-to-chest stretches, hugging your knees for 30 to 60 seconds
• Aquatic therapy to alleviate pressure on the spine while exercising
• Walking for 10 to 20 minutes per day
• Spinal manipulation, a procedure commonly used by chiropractors

Surgery and Specialist Procedures

If conservative measures fail, your healthcare provider may recommend specialist procedures or surgeries, such as:

• Lumbar intra-articular injections, which deliver an anesthetic or corticosteroid (steroid) into the spine for longer-lasting pain relief
• Sinuvertebral nerve ablation, which destroys spinal nerves with a strong electrical current
• Extracorporeal shockwave therapy (ESWT), which delivers low- or high-energy electrical pulses to help ease pain
• Stem cell regeneration, an experimental procedure in which your own stem cells are harvested and injected into damaged joints to potentially restore function
• Facet rhizotomy, a surgical procedure used to sever one of the nerves supplying the facet joint
• Spinal fusion surgery, a surgery that fuses two or more vertebrae to eliminate movement and pain in the facet joints