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Facet Arthroplasty - Facet Joint Arthritis

Below are some common questions asked:

  • What causes facet arthropathy?
  • What are the symptoms?
  • How is facet arthropathy diagnosed and treated?
  • What are the symptoms?
  • How is facet arthropathy diagnosed and treated?

Where and what are Facet Joints?

Facet joints are found in the posterior of the spine. There are 24 vertebrae which form the human spine. There are two facet joints between the vertebrae of each spinal segment along the spinal column.

Located next to each vertebrae in the spine there is a 3 joint complex space which house facet joints and discs.

Facet Joint Spine

Facet joints, also known as zygapophysial joints, are paired joints that lie more to the back of the spinal column, providing the rear connection between adjacent vertebrae. Although small, they are typical of most other joints of the body, in that they are lined with cartilage and are coated with a lining of joint fluid (called synovial fluid), which is contained within a joint capsule.

These joints are supplied by a nerve supply, and thus, when the joint is damaged or inflamed, it can produce pain. Whilst the stability of an inter -vertebral joint is provided mainly by the disc, the facet joints are also essential for stability, particularly if the disc has degenerated.

What is Facet Arthropathy?

Facet Arthropathy is degenerative arthritis affecting the facet joints in the spine. In the area of the spine where there are facet joints, arthritis pain can develop.

What Can Cause Facet Arthropathy?

Arthritis in the facet joints can develop from:

  • Wear and tear (discs wear out in the space between vertebrae causing facet joints to rub together)
  • Previous back injury
  • Fractures
  • Ripped/Damage ligaments
  • Disc problems

Who Can Develop Facet Arthropathy?

Other than the aforementioned injuries, facet arthopathy is a condition of aging. The primary cause of facet arthropathy is spinal degeneration which typically occurs in later life.

What are the Symptoms of Facet Arthropathy?

Pain is the main symptom associated with facet arthopathy. The pain is typically worse following sleep or rest. Pain associated with facet arthropathy may be exacerbated by twisting or bending backwards. Low back pain is the most frequent complaint but it does not typically radiate down the legs or buttocks, unless spinal stenosis also is involved.

How is Facet Arthropathy Diagnosed?

X-rays, CAT scans, and Magnetic Resonance Imaging (MRI) may be used to help diagnose facet arthropathy. Another procedure which is more specific involves performing a guided injection using a fluroscope. Medicine and dye are injected. The dye allows the doctor to view the placement of the needle and injection. If the facet joint is injected and pain relief is the result, that serves to confirm the diagnosis of facet arthropathy.

How is Facet Arthropathy Treated Conservatively?

Initially the doctor may recommend a period of rest in an effort to tame the symptoms. Sleep positions which take pressure off facet joints may be recommeded (i.e. curl up to sleep or lay on back with knees up and pillow underneath).

Some oral medication may be prescribed including:

  • Tylenol
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Corticosteroids

Other treatment options include:

  • Strengthening and aerobic exercise
  • Water therapy
  • Spinal manipulation

What Aggressive Treatments May Help Facet Arthropathy?

If conservative measures fail:

  • Injections of an anesthetic or steroid medicine into the facet joint or nerves that go to the facet joint may be tried
  • Sinu-vertebral nerve ablation which destroys nerves with electrical current may be an option
  • Surgery is rarely required for facet arthropathy but options do exist

What Surgical Options Exist for Facet Arthropathy?

Surgical options to treat facet arthropathy include:

  • Facet rhizotomy - sever one of the nerves going to facet joint
  • Fusion - fuse two or more vertebrae to eliminate movement in facet joints (sometimes facet joints are removed during spinal fusion)

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