Facet Joint Osteoarthritis|
Facet Joints The front or anterior portion of the spine is made up of a series of bones (the vertebral bodies) that are stacked like blocks on top of one another with discs in between to help in all load-bearing tasks. The facet joints (or spinal joints) are positioned at the rear or posterior portion of the thoracic and lumbar spine and connect the individual vertebrae. Each vertebra has two pairs of facet joints, with one pair facing upward to connect with the vertebra above it and the other pair facing downward to connect with the vertebra below it. The facet joints allow the vertebra to move against and in relation to one another, effectively providing us with the stability and flexibility we need to twist and to bend forward, backward, and from side to side. The structure and the function of the facet joints are altogether similar to that of other joints in the body. The surfaces of the joints are outfitted with a layer of cartilage that allows the bones they mediate to pivot with a minimum of friction. The facet joint is surrounded by a joint capsule made up of ligaments and connective tissues that help to hold the joint together. |
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Like all other joints, facet joints are subject to age-related degenerative processes. Although the facet joints are usually exposed to a relatively small degree of load stress in younger individuals, this stress increases dramatically - and can have a dramatic effect - as other parts of the spine begin to degenerate. The most common cause here is a decrease in the space between the vertebrae as the intervertebral discs begin to flatten out as a result of wear and tear. Loss of intervertebral space also results from disc herniation and the surgical removal of discs. A reduction in the height of the discs of only a few millimeters leads to an enormous increase in the load on the facet joints. This problem tends to be compounded by obesity, insufficient muscle support and osteoporosis.
The most common symptom associated with facet joint osteoarthritis is pain upon movement and loading. Pain is experienced in the morning as the spine, which is now called upon to carry the weight of the body after an unloaded phase, begins to compress and the facet joints' worn cartilage surfaces come into contact with one another. This pain tends to be continuous and tends to increase as soon as the spine is called upon to handle additional stress, for instance, the stress associated with bending and twisting. Unfortunately, damaged joints tend to show osteophytic reactions. This means that they tend to produce new, but superfluous outgrowths of bone as a response to wear and tear. Such outgrowths in the facet joints can pinch nerve roots in the spine and cause considerable back pain as well as referred pain in the legs.
Treatment for facet joint osteoarthritis essentially encompasses the entire spectrum of conservative options, including physical therapy. Treatment geared to eliminating the cause of facet joint osteoarthritis is seldom an option because the degenerative processes involved - in other parts of the spine (e.g. intervertebral disc wear) or in the facet joints themselves - will usually have advanced too far. In such cases, it is important to treat the symptoms. At our clinic, we have achieved excellent outcomes with a thermocoagulation procedure that enables a controlled, local destruction of pain receptors and brings about a significant reduction in back pain over the course of one to two years.
