Facet Arthrosis

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Original Editor - Niha Mulla

Top Contributors - Niha Mulla  

Definition and introduction

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.

Clinical relevance

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.

Causes

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:

• 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:

• 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

Risk factors

Possible risk factors include:

• 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

Pain is the most common symptom of facet arthrosis; while nature of pain associated with the condition may vary:

• 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

• 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.
• 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.

Differential Diagnosis

Differential diagnoses for facet arthrosis include:

• 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

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:

• 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

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