What is Facet Joint Disease?
Facet joints are what we call the connection points between two adjoining backbones, or vertebrae. These are a special type of joint, called synovial joints, which are encapsulated by a fibrous envelope that continues into the bone surface. These joints also contain a lubricating fluid, maintained within the joint by an interior membrane. The primary function of these joints is enabling our spine to bend and straighten, while also ensuring it cannot rotate excessively or permit the vertebrae to slide over one another.
The feeling in these joints is provided by the medial branch of a nerve originating from the backbone. There is a condition called facet syndrome where these very joints cause pain and lead to disability. This type of pain is frequently the cause of long-term lower back pain, affecting 15 to 41% of people. This condition is noteworthy due to its significant economic impact as it often leads to disability.
What Causes Facet Joint Disease?
The main cause of facet joint disease is when the spine starts to breakdown, a condition referred to as spondylosis. If this breakdown is due to natural wear-and-tear or unusual body mechanics, it’s known as osteoarthritis. The exact process by which osteoarthritis develops is complex and isn’t fully known, but it involves certain proteins and other factors that your body naturally produces, as well as certain risk factors unique to each person.
Other causes of facet joint disease can include injury or activities related to sports. Inflammatory conditions like rheumatoid arthritis and ankylosing spondylitis may play a part because they cause inflammation of a joint’s lining. Facet joint disease can also develop if the facet joints, that is, the small joints in your back that make your spine flexible, move out of their normal position due to a condition called spondylolisthesis.
Individuals with facet joint disease have erosion and inflammation in their cartilage, which can cause pain. The body also reacts to these changes in several ways. Ligaments, like the ligamentum flavum, can become thicker and larger. The formation of new bone around the joint can happen, leading to the development of bone spurs. There can also be an increase in the volume of the bone just below the cartilage along with reduced mineral content.
Risk Factors and Frequency for Facet Joint Disease
Low back pain is a common health issue in the United States, affecting 65 to 80% of adults during their lifetime. This statistic often relates to the rising problem of facet joint disease in older adults. This disease comes from the degeneration of certain spine joints, usually due to age. Despite common beliefs, no concrete evidence suggests that men are more affected than women.
Several factors increase the risk of developing facet joint disease. For instance, doing heavy physical work before the age of 20 and being overweight both contribute to this condition. These activities exacerbate joint wear and tear leading to osteoarthritis, which often counts as a leading cause of facet joint disease.
- Spondylolisthesis, a condition where a bone in the spine moves out of place, is frequently a result of facet joint osteoarthritis. This usually happens in the spine’s L4-L5 level.
- In younger people (aged 30 to 40), spondylolisthesis can occur due to inborn abnormalities, stress, or sudden fractures.
- Between 29 to 60% of whiplash injuries lead to cervical facet disease and related pain. However, these injuries are not widespread causes of trauma.
Signs and Symptoms of Facet Joint Disease
Facet joint disease, which often causes chronic back pain, is usually diagnosed using a patient’s medical history and a physical exam. The pain typically gets worse in the morning or after periods of inactivity, and can also increase when the spine is extended, when the facet joint is touched, or when the trunk of the body is rotated. Certain movements, such as Kemp’s maneuver (back extension while rotating and leaning backwards), lateral rotation, lateral bending, and back extension, can also trigger the pain, indicating the possible presence of facet joint disease.
Patients typically feel this pain in the lower back. It’s often unilateral, meaning it is felt on one side of the body, and may also radiate into the buttock, groin, thigh, and even down to the knee. Sometimes, the pain can also spread to the abdominal and pelvic areas, but this is less common. It’s worth noting that this radiating pain doesn’t come with any neurological deficits, meaning it doesn’t cause conditions like numbness or weakness in the limbs.
The pain can mimic the sensation associated with sciatica, especially in cases where bony growths known as osteophytes, or fluid-filled sacs called synovial cysts, have formed. But it’s important to exclude other potential causes of lower back pain, such as a slipped disc, fractures in the vertebral body, and tumors.
Testing for Facet Joint Disease
It can be quite tricky to determine whether facet joint disease is the only cause of a person’s neck or back pain. Medical scans like X-rays, CT scans, and MRI scans have not proven to be very accurate in diagnosing this condition. These scans might show some signs of wear and tear, narrowing of the joint space, enlargement of the facet joints, hardening of the joint space, and bony growths. However, these signs can appear in people experiencing pain, as well as those who don’t feel any discomfort.
Studies show that 89% of people aged 60 to 69 have facet joint arthritis, but not all of them have symptoms. Therefore, to diagnose facet joint pain correctly, doctors often use a technique known as the medial branch block. This procedure involves applying medication to the medial nerve branches that control sensation to the facet joints. This is considered the most reliable way to identify facet joint pain.
A positive response to a set of 2 diagnostic blocks performed at different times and at more than one level of the spine can help confirm the source of the pain. However, it’s important to note that false positives, or incorrect test results that indicate the presence of a condition when it’s not really there, are more likely to happen if the nerve block is administered at only one level of the spine.
Treatment Options for Facet Joint Disease
Conservative management, including simple measures such as anti-inflammatory medications, weight loss, muscle relaxers, physical therapy, and massage, is often the first course of action for treating facet-mediated pain, which is pain coming from the small joints in your spine. All of these treatments can be used together in order to achieve the best effect.
If these basic treatments are not effective, then other interventions can be considered. One of these is diagnostic medial branch blocks, which are procedures used to confirm that the pain is indeed coming from the facet joints in your spine. Due to the high rate of false positives after a single block, two of these procedures are often performed. A false positive means the procedure initially appears to work, but the pain is not actually coming from the facet joints.
If a patient responds positively to these blocks, meaning their pain significantly decreases, they can have a procedure called radiofrequency ablation. This procedure uses heat to temporarily destroy the pain-transmitting nerves in your back, reducing your pain. Studies have shown that improvements in function and reductions in pain can last anywhere from 6 to 12 months after this procedure. However, since nerves in the body have the ability to regenerate, or grow back, the procedure can be repeated as needed, typically in 6 to 12 months, when the pain returns.
It’s important to note that there are currently no guidelines for turning to surgery, specifically a surgical procedure known as arthrodesis, when other treatments fail. Arthrodesis, or spinal fusion, merges two or more spinal bones (vertebrae) together into one solid piece. Surgery might be considered for a condition called spondylolisthesis, where a vertebra of the lower spine slips out of place, but it is not the first choice for treatment and doesn’t always eliminate the pain.
What else can Facet Joint Disease be?
Here are some health conditions that could be mistaken for lower back pain:
- Sciatica
- Hip osteoarthritis
- Sacroiliac impingement
- Lumbar radiculopathy
- Myofascial pain
- Compression fractures
- Disc herniation
- Osteophytes
- Rheumatoid arthritis
What to expect with Facet Joint Disease
Facet joint disease is a long-term condition that can cause ongoing pain for someone’s entire life. This disease tends to get worse over time. The degeneration, or breakdown, of the spine and joints generally increases as a person gets older. To slow down this process, it’s crucial to maintain a healthy weight and stay active. Regular physical therapy and exercises to strengthen the core can reinforce the spine and decrease pressure on the facet joints.
Certain procedures like medial branch blocks and radiofrequency ablations might not cure the root cause of the pain. However, they can make the pain more bearable for the patient. These procedures can offer pain relief lasting for several months. Some studies have even indicated that pain can be reduced for up to 2 years following radiofrequency ablations.
Possible Complications When Diagnosed with Facet Joint Disease
Facet joint pain treatment through methods like medial branch blocks or radiofrequency ablation seldom leads to complications. However, after these procedures, some patients can temporarily experience more pain due to the effects of heat denervation and the insertion of the needle. Other infrequent potential complications include headaches after the healing of dural punctures, temporary numbness or weakness, bleeding, infection, and increased pain after the procedure.
Common Side Effects:
- Transient increase in pain due to heat denervation and needle insertion
- Post-dural headaches
- Temporary numbness or weakness
- Bleeding
- Infection
- Increased pain after the procedure
Preventing Facet Joint Disease
Teaching patients about their condition is highly important, especially for those being treated for pain. People should understand that facet joint disease is a condition that lasts a lifetime and can worsen over time. It’s also key to remember that it’s usually not possible to completely get rid of the pain associated with this disease.
Preventing the disease from getting worse is crucial and can be achieved through maintaining a healthy lifestyle, eating a balanced diet, and regular exercise. This can help reduce pressure on the facet joints, which are small joints at each segment of the spine that provide stability and help guide motion. By lessening the stress on these joints, it can help decrease inflammation (swelling) and the associated pain.