Facet Arthrosis

Original Editor - Niha Mulla

Top Contributors - Niha Mulla  

Definition and introduction[edit | edit source]

Facet Joints.png

Facet arthrosis is a painful arthritis-like condition of the spine caused by degeneration of the joints between the spinal bones.

The spine is made up of vertebrae and between each vertebra are two facet joints cushioned by cartilage and lubricated by synovial fluid. These facet joints run alongside the vertebrae posteriorly and and help with twisting and turning motions of the spine. [1][2][3]

Facet Joints Anatomy.jpeg

Clinical relevance[edit | edit source]


Facet joints degenerate, wear down with age, leading to facet arthrosis. The cartilage of the facet joints, wears down and gets damaged due to trauma or/and aging causing friction in-between joints leading to inflammation, swelling and stiffness; which further causes discomfort and extreme pain. [1][2][3]

Causes[edit | edit source]

Aging is one of the most common causes of facet arthrosis as spinal degeneration is the principal cause of facet arthrosis.  

Other reasons that can cause facet arthrosis are as follows: [1][2][3]

  • Osteoarthritis of facet joint
  • Wear and tear of the facet joints
  • Direct trauma to the facet joint, such as a car accident or fall.
  • Microtraumas to the area
  • Obesity
  • Poor body mechanics, such as bad posture
  • Synovial cyst which is a fluid-filled sac on the spine, which in turn puts pressure on the spinal nerves.
  • Damaged spinal discs from injury.
  • Rheumatoid arthritis:  This condition causes damages to the facet joints, especially, mid-lumbar and lower lumbar areas.
  • Torn ligaments
  • Disc problems

Pain in the lower back can result from numerous causes. According to Dan Brennan, MD; in his article “What Is Facet Arthrosis?” on Webmed, other low back pain can be differentiated from facet joint pain or facet arthrosis by watching for the following symptoms:[1]

  • Lower back pain that is worse in the morning
  • Pain that increases during times of inactivity
  • Pain during spinal flexion or while performing a twisting motion
  • Pain that usually stays in one place, but can radiate to other areas of the body

Types of facet arthrosis[edit | edit source]

  1. Bilateral facet arthrosis; where both sides of the facet joint are damaged.
  2. Cervical facet arthrosis; where facet joints of neck (C1-C7)are involved.
  3. Degenerative facet arthrosis; which is also known as facet joint arthropathy degenerative joint disease or osteoarthritis.
  4. Hypertrophic facet arthrosis; where degenerated joints have enlarged in size.
  5. Lumbar facet arthrosis; where facet joints of lower spine (L1-L5) are damaged.
  6. Multilevel facet arthrosis; where multiple joints at multiple levels of spine are involved.
  7. Thoracic facet arthrosis; where facet joints of upper back (T1-T12) are damaged. [4]

Risk factors[edit | edit source]

Possible risk factors include:[2][5]

  • Age: Common in older people.
  • Gender/Sex: More common in females than in males.
  • Obesity: Three times higher risk in people with body mass index of 25-30 kg/m2 while five times higher risk in people with body mass index of 30-35 kg/m2.

Signs and symptoms[edit | edit source]

Pain is the most common symptom of facet arthrosis; while nature of pain associated with the condition may vary:[2][3][6][7]

  • Back pain and/or neck pain (depending on area of involvement of facet arthrosis) and the pain is aggravated on bending, leaning backward, when twisting sideways, lifting objects, or standing.
  • Constant dull aching pain on back and/or neck on one or both sides.
  • Pain centered in a specific area of the spine.
  • Pain worsens after sleep or rest.
  • Pain is relieved with sitting or changing positions.
  • Stiffness around part of the back and/or neck (depending on area of involvement of facet arthrosis)

Evaluation and diagnosis of facet arthrosis[edit | edit source]

  • X-rays, and computed tomography (CT) scans and  magnetic image resonance (MRI) show if arthrosis has caused any visible damage to your facet joints and surrounding tissue.[1]
  • A technique called a diagnostic medial branch block is often the surest way of obtaining a diagnosis of facet arthrosis. Medial branch blocks are injections, that are inserted near the medial nerve, of the facet joint. A set of two injections are performed at different times. If both injections cause the pain to stop for a period of time by at least 80%, it’s usually a confirmation of facet arthrosis. This techniques is also used as a from of treatment by doctors to teat facet arthrosis.[1][2][3][8]

Differential Diagnosis[edit | edit source]

Differential diagnoses for facet arthrosis include:[9]

  • Herniated disc
  • Discogenic pain syndrome
  • Paraspinal muscle/ligament sprain/strain
  • Spondylosis/spondylolysis/spondylolisthesis
  • Rheumatoid arthritis (more common in cervical)
  • Seronegative spondyloarthritis (most commonly ankylosing spondylitis, psoriatic arthritis, reactive arthritis)
  • Gout
  • Diffuse idiopathic skeletal hyperostosis
  • Sacroiliac joint dysfunction (common in lumbar facet arthrosis)
  • Fascia dysfunction
  • Neoplasm
  • Fibromyalgia

Complications[edit | edit source]

Facet arthrosis is a is a progressive disease/condition that usually does not go away completely. But pain can be managed using various treatments. Pain can get worst is measures are not taken in time to manage it; also other complications may arise of it.

Some complications that may arise if facet arthrosis is left untreated are as follows:[1]

  • Bone spur: A joint degenerated with facet arthrosis has a worn-out cartilage. When left untreated, with time as the degeneration further progresses, the bones of the joint start touching each other. Severe pain arises as these bones rub together. This can cause a condition known as bone spur. As the joint is normally protected by the cartilage, the outer parts of your bones are normally smooth. When bone spur is developed, the bones become rough at the places where they rub together. This itself causes pain. The pain becomes more intense as he spur reach a nerve.
  • Joint enlargement: Effected facet joint gets enlarged/bigger as a result of arthrosis. It can also lead to enlargement of surrounding tissues like ligaments.

Prevention[edit | edit source]

Although it is not possible to prevent facet arthrosis from occurring, following measures can be taken to reduce the risk of developing facet arthrosis.[2]

  • Maintain ideal body weight.
  • Exercise regularly
  • Avoid injury
  • Do not twist the back too much when lifting any kind of heavy weight.
  • Maintaining good posture
  • Eating a healthy, balanced diet and quit smoking as these acts effects bone health.
  • Vitamin D and calcium supplements are known to be useful to maintain good bone health.

Treatment[edit | edit source]

There is no cure for facet arthrosis and the first line of treatment is typically the least invasive. Treatment is aimed at relieving pain and stiffness, along with muscle strengthening to keep the patient as active and independent as possible.[1][2][3][4]

  • Initially, patient is recommended a period of rest to tame the symptoms.
  • Oral medications are prescribed by the physician; such as Tylenol (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and corticosteroids.
  • Physical therapy
  • Epidural injections: Anesthetic or steroid injection is directly injected into the spine, into the facet joint or nerves that go to the facet joint.
  • Sinu-vertebral nerve Radiofrequency ablation: This procedure uses radiofrequency waves to shut down the function of the affected facet joint nerve and prevent it from sending pain signals to the brain.
  • Surgery may be performed when there is severe compression of the nerve: Facet rhizotomy or Fusion is performed where the surgeon, fuses two or more vertebrae to eliminate movement in facet joints. Sometimes facet joints are also removed during spinal fusion.

Physical therapy interventions[edit | edit source]

Physical therapy is focused on strengthening and stretching the affected muscles along with reduction of inflammation and pain.[1][2][3][4][10][11][12][13]

  • Heat or ice packs applied to the affected area.
  • Ice is more useful in the acute and sub-acute phase of the pain: apply ice to the area of spine, that is painful; to help reduce pain and associated muscle spasm. Ice is to be applied for an interval of about 20 minutes at a time.
  • Bracing/Belt/supports may be necessary to reduce stress on the facet joints, muscles and spine.
  • Ergonomic correction: Sleep positions that take the pressure off facet joints are recommended, such as curling up to sleep or lying on the back with legs up by using pillow support underneath. Also, patient is asked to avoiding movements that cause the pain to flare up; for example, patient should avoid lifting, repetitive twisting, or overextending the spine.
  • Traction
  • Water therapy
  • Spinal manipulation
  • Aerobic exercises: slow walking, stationary cycling, Elliptical machine can be used.
  • Strengthening exercises: Clamshell, Mini Squats, Bird-dog are useful.
  • Stretching exercises: Hip flexor stretch, One knee to chest, Both knees to chest, Cat/Cow, Child’s pose, Foam Rolling, Pelvic tilt lying on the floor
  • Core strengthening exercises are recommended as pain starts to subside.

Prognosis[edit | edit source]

  • Facet arthrosis and pain associated with it will increases with age.
  • Conservative management, such as physical therapy is the first line in management.
  • Patients who fail to respond to physical therapy may undergo diagnostic block of the facet joint. [9]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Brennan D. Facet arthrosis: What is it and what causes it? WebMD; 2021 June 15. Available from: https://www.webmd.com/arthritis/what-is-facet-arthrosis
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Rohini Radhakrishnan. Is facet arthropathy serious? causes & symptoms. MedicineNet; 2021 November 17. Available from: https://www.medicinenet.com/is_facet_arthropathy_serious/article.htm
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Eustice C. Learn how facet arthropathy causes low back pain. Verywell Health; 2022 February 2. Available from: https://www.verywellhealth.com/facet-arthropathy-treatment-190440
  4. 4.0 4.1 4.2 What is Facet Arthropathy? Stanford Health Care (SHC) - Stanford Medical Center. Available from: https://stanfordhealthcare.org/medical-conditions/back-neck-and-spine/facet-arthropathy/types.html
  5. Eubanks JD, Lee MJ, Cassinelli E, Ahn NU. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine. 2007 Sep 1;32(19):2058-62.
  6. Berry J. Facet arthropathy: Symptoms, causes, and risk factors. Morrison W, editor. Medical News Today. MediLexicon International; 2017 December 19. Available from: https://www.medicalnewstoday.com/articles/320355
  7. Eisenstein SM, Parry CR. The lumbar facet arthrosis syndrome. Clinical presentation and articular surface changes. The Journal of Bone and Joint Surgery. British volume. 1987 Jan;69(1):3-7.
  8. Park D, Throckmorton T, Fischer S. Spinal injections - orthoinfo - AAOS (The American Academy of Orthopedic Surgeons) 2022 February. Available from: https://orthoinfo.aaos.org/en/treatment/spinal-injections/
  9. 9.0 9.1 Mann SJ, Viswanath O, Singh P. Lumbar facet arthropathy.
  10. Lumbar facet arthropathy. Twin Boro Physical Therapy. 2022. Available from: https://twinboro.com/body/spine/lumbar/joint/conditions/lumbar-facet-arthropathy-nj.html#:~:text=Common%20Physical%20Therapy%20interventions%20in,motion%20of%20the%20lumbar%20spine.
  11. Exercises for back pain due to facet joint impingement/osteoarthritis. Wilderman Medical Clinic - Pain Clinic in Toronto Area. 2015. Available from: https://drwilderman.com/exercises-for-back-pain-facet-joint-impingement/
  12. Gentle exercise can help reduce facet joint pain. Sperling Medical Group. 2017. Available from: https://sperlingmedicalgroup.com/gentle-exercise-can-help-reduce-facet-joint-pain/
  13. Facet joint pain: Symptoms, exercises, and treatments. IPS Columbus. 2021. Available from: https://ipscolumbus.com/2021/12/20/facet-joint-pain-symptoms-exercises-and-treatments/