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What is Facet Arthropathy?
Understanding a frequent cause of back pain.

Facet arthropathy is a frequent cause of chronic back and neck pain, can significantly impact an individual's quality of life, limiting mobility and diminishing overall well-being. Understanding this condition and the available treatment options is crucial for those seeking relief from its debilitating symptoms. 

Facet arthropathy, also known as facet joint osteoarthritis, occurs when the small joints located between the vertebrae in the spine become inflamed or degenerated over time. This degeneration can lead to stiffness, decreased range of motion, and persistent pain in the affected area.  Facet arthropathy is a common cause of low back pain and neck pain. 

Arthritis of spine

Risk Factors

Several risk factors can increase the likelihood of developing facet arthropathy:

  • Age:  The risk of facet arthropathy increases with age, as the facet joints undergo wear and tear over time.

  • Previous Trauma or Injury: Previous injuries to the spine, such as fractures or dislocations, can accelerate the degeneration of facet joints and increase the risk of developing facet arthropathy.

  • Obesity:  Excess body weight places increased stress on the facet joints, leading to faster degeneration and a higher risk of developing arthropathy.

  • Genetics: Some individuals may have a genetic predisposition to developing facet arthropathy, making them more susceptible to the condition.

  • Occupational Factors: Jobs or activities that involve repetitive or strenuous movements of the spine, such as heavy lifting or prolonged sitting, can contribute to facet joint degeneration and increase the risk of facet arthropathy.

  • Poor Posture: Maintaining poor posture over time can place uneven pressure on the facet joints, leading to accelerated degeneration and an increased risk of developing arthropathy.

  • Degenerative Disc Disease: Degenerative changes in the intervertebral discs can alter the biomechanics of the spine, placing additional stress on the facet joints and increasing the risk of facet arthropathy.

  • Joint Misalignment: Structural abnormalities or misalignment of the spine can lead to uneven loading of the facet joints, contributing to degeneration and the development of facet arthropathy.

  • Lack of Exercise: Sedentary lifestyles or lack of regular exercise can weaken the muscles supporting the spine, leading to instability and increased stress on the facet joints, thereby increasing the risk of arthropathy.

  • Smoking: Tobacco use can impair blood flow to the spine, reduce the delivery of nutrients to the facet joints, and accelerate degeneration, increasing the risk of facet arthropathy.

  • Ankylosing Spondylitis: Autoimmune disorder that leads to inflammation and in advanced cases, autofusion of the facet joints.

Symptoms

There are certain symptoms which are consistent with arthritis of the facet joints:

  • Localized Back or Neck Pain: Pain in the area of the affected facet joints, which are located on the back of the spine. The pain may be dull, achy, or sharp and may worsen with certain movements or activities, especially twisting and leaning back.

  • Radiating Pain: Pain may radiate into other areas of the body, such as the buttocks, hips, thighs, or shoulders, depending on the location of the affected facet joints. This pain may mimic the symptoms of conditions like sciatica or cervical radiculopathy.

  • Stiffness and Reduced Range of Motion: Facet arthropathy may cause stiffness and decreased flexibility, making it difficult to bend, twist, or turn back or neck. This stiffness may be more pronounced in the morning or after periods of inactivity.

  • Tenderness to Touch: The area around the affected facet joints may be tender to the touch, and massage therapies may cause an increase in pain.

  • Muscle Spasms:* The muscles surrounding the affected facet joints may go into spasm in response to pain or instability in the spine, causing additional discomfort and reduced flexibility.

  • Pain with Certain Movements: Certain movements or positions of the spine, such as leaning backward or twisting, may exacerbate facet joint pain.

  • Pain Aggravated by Weight-Bearing Activities: Activities that place stress on the facet joints, such as standing, walking, or lifting, may increase pain.

Treatment

Treatment for facet arthropathy aims to alleviate pain, improve mobility, and enhance quality of life.

The approach to treatment may vary depending on the severity of symptoms and individual patient factors. Here are some common treatment options for facet arthropathy:

  • Medications: 

    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen or naproxen can help reduce inflammation and relieve pain associated with facet arthropathy.

    • Analgesics: Pain medications such as acetaminophen may be prescribed to alleviate discomfort.

    • Muscle Relaxants: These medications can help reduce muscle spasms and improve mobility.

  • Physical Therapy: A tailored physical therapy program can help strengthen the muscles supporting the spine, improve flexibility, and promote proper posture. - Therapeutic exercises, stretches, and manual therapy techniques may be prescribed to alleviate pain and improve range of motion.

  • Intra-Articular Facet Joint Injections: Corticosteroid injections directly into the affected facet joints can provide relief by reducing inflammation and pain.

  • Medial Branch Blocks:- These are injections of local anesthetic that temporarily blocks the nerves that supply the facet joints.  If there is short-term (think in hours, not days or weeks) relief from two rounds of these blocks typically a Radiofrequency Ablation will be schedule for longer term pain relief.

  • Radiofrequency Ablation (RFA):  RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to selectively ablate the nerves that supply the facet joint.  using heat or chemical agents. - RFA can provide significant pain relief for several months to years, depending on the individual.

  • Lifestyle Modifications:  Adopting healthy lifestyle habits such as maintaining a healthy weight, practicing good posture, and avoiding activities that exacerbate symptoms can help manage facet arthropathy. - Physical activity and regular exercise, such as low-impact exercises and stretching, can also help improve spinal health and reduce pain

  • Alternative Therapies:  Some individuals may find relief from facet arthropathy symptoms through alternative therapies such as acupuncture, chiropractic care, or massage therapy. - While these therapies may not directly address the underlying cause of facet arthropathy, they can help manage pain and improve overall well-being.

Injection therapies can be highly effective for managing facet arthropathy, but they are not a cure for the underlying degenerative changes in the facet joints. At this time there is no way to reverse degenerative changes in the facet joints, and surgery is typically not a solution. However, by reducing pain and inflammation, injection therapies have the ability to improve function and quality of life, allowing patients to participate more fully in daily activities and rehabilitation programs.

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