What is facet arthropathy?

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.

The facet joints and disc space form a three joint complex near each vertebrae. A facet joint has two bony surfaces with cartilage between them and a capsule of ligaments surrounding it. Synovial fluid lubricates the joints as is the case with any joint.

Simply put, 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.

Arthritis in the facet joints can develop from:

• wear and tear (decreases space between vertebrae causing facet joints to rub together)
• previous back injury
• fractures
• torn ligaments
• disc problems

Due to the additional stress caused by these circumstances on the facet joints, bone spurs can develop and cartilage can deteriorate.

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.

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.

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

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
• Facet rhizotomy/ablation which destroys nerves with heat energy may be an option
• surgery is rarely required for facet arthropathy but options do exist

Surgical options to treat facet arthropathy include:

• Fusion – fuse two or more vertebrae to eliminate movement in facet joints (sometimes facet joints are removed during spinal fusion)